Provider Demographics
NPI:1093509416
Name:HULTGREN, AVA RAE (DC)
Entity type:Individual
Prefix:DR
First Name:AVA
Middle Name:RAE
Last Name:HULTGREN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARKET ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6279
Mailing Address - Country:US
Mailing Address - Phone:802-777-1913
Mailing Address - Fax:
Practice Address - Street 1:4 MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6279
Practice Address - Country:US
Practice Address - Phone:802-777-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0134218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor