Individual
THOMAS VANIDESTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
9975 SW FREWING ST, SUITE #210, TIGARD, OR 97223-5091
(503) 444-1953
(971) 244-7246
Mailing address
9975 SW FREWING ST, SUITE #210, TIGARD, OR 97223-5091
(503) 444-1953
(971) 244-7246
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5773
OR
Other
Enumeration date
11/17/2016
Last updated
08/30/2023
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