Organization
VANFOSSEN LLC
Active
Other names
HealthSource of Southside Aiken
Organization subpart
No
Provider details
NPI number
Authorized official
ETHAN VANFOSSEN (OWNER)
(864) 303-2679
Entity
Organization
Contact information
Practice address
550 SILVER BLUFF RD STE 200, AIKEN, SC 29803-7835
(864) 303-2679
(330) 319-8842
Mailing address
2170 PINE LOG RD, WARRENVILLE, SC 29851-3416
(864) 303-2679
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
12/17/2018
Last updated
01/02/2019
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