# THOMAS J VANIDESTINE JR

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487600011
- **Authorized official:** THOMAS J VANIDESTINE JR. DC (OWNER)
- **Authorized official phone:** (207) 942-2800

## Contact information

- **Practice address:** 336 MOUNT HOPE AVE, SUITE 11, BANGOR, ME 04401-4236
- **Practice address phone:** (207) 942-2800
- **Practice address fax:** (207) 990-2362
- **Mailing address:** 336 MOUNT HOPE AVE, SUITE 11, BANGOR, ME 04401-4236
- **Mailing address phone:** (207) 942-2800
- **Mailing address fax:** (207) 990-2362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | Yes |
| 111N00000X | Chiropractor | — | — | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 03/16/2017