Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 30-431 | MT |
NPI | 1225115116 |
---|---|
Provider Name | Dr. Randall Scott Hultgren |
First Address | Billings, MT 59102-3346 |
Second Address | Billings, MT 59102-3346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160329 | (05) | MT |
T60135 | (02) | MT |