Organization
THOMAS J VANIDESTINE JR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J VANIDESTINE JR. DC (OWNER)
(207) 942-2800
Entity
Organization
Contact information
Practice address
336 MOUNT HOPE AVE, SUITE 11, BANGOR, ME 04401-4236
(207) 942-2800
(207) 990-2362
Mailing address
336 MOUNT HOPE AVE, SUITE 11, BANGOR, ME 04401-4236
(207) 942-2800
(207) 990-2362
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
05/25/2006
Last updated
03/16/2017
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