Provider Demographics
NPI:1538434261
Name:HEALTHSOURCE OF ANDERSON-WEST
Entity type:Organization
Organization Name:HEALTHSOURCE OF ANDERSON-WEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:864-226-8562
Mailing Address - Street 1:918 HIGHWAY 28 BYP
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29624-1114
Mailing Address - Country:US
Mailing Address - Phone:864-226-0124
Mailing Address - Fax:864-231-9227
Practice Address - Street 1:918 HIGHWAY 28 BYP
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-1114
Practice Address - Country:US
Practice Address - Phone:864-226-0124
Practice Address - Fax:864-231-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty