Vanfossen LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

VANFOSSEN LLC

Doing business as

HealthSource of Southside Aiken

Practice address

550 Silver Bluff Rd Ste 200
Aiken, SC 29803-7835

Phone

(864) 303-2679

Fax

(330) 319-8842

NPI assigned

Dec 17, 2018

Last updated

Jan 2, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ethan Vanfossen

Title

Owner

Phone

(864) 303-2679

Specialties & licenses 1

Addresses

Other names 1

• HealthSource of Southside Aiken Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546387200000",
    "number": "1417429374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2170 PINE LOG RD",
            "city": "WARRENVILLE",
            "state": "SC",
            "postal_code": "298513416",
            "telephone_number": "864-303-2679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 SILVER BLUFF RD STE 200",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298037835",
            "telephone_number": "864-303-2679",
            "fax_number": "330-319-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANFOSSEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2019-01-02",
        "status": "A",
        "authorized_official_last_name": "VANFOSSEN",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-303-2679"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSource of Southside Aiken",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Aiken, SC
• Providers in Aiken, SC by specialty
• Chiropractor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.