Healthcare Provider Details

I. General information

NPI: 1225115116
Provider Name (Legal Business Name): RANDALL SCOTT HULTGREN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 AVE B
BILLINGS MT
59102-3346
US

IV. Provider business mailing address

944 AVE B
BILLINGS MT
59102-3346
US

V. Phone/Fax

Practice location:
  • Phone: 406-259-1250
  • Fax: 406-259-5043
Mailing address:
  • Phone: 406-259-1250
  • Fax: 406-259-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number30-431
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: