Organization
PINE TREE WHOLISTIC HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J VANIDESTINE JR. DC,CCSP (PRESIDENT)
(207) 942-2800
Entity
Organization
Contact information
Practice address
336 MOUNT HOPE AVE, SUITE 11, BANGOR, ME 04401-4236
(207) 942-2800
Mailing address
336 MOUNT HOPE AVE, SUITE 11, BANGOR, ME 04401-4236
(207) 942-2800
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
02/11/2016
Last updated
02/11/2016
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