Healthcare Provider Details

I. General information

NPI: 1073723425
Provider Name (Legal Business Name): BRADLEE N NOVOTNY, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 N 7TH ST
LINCOLN NE
68521-2425
US

IV. Provider business mailing address

4401 N 7TH ST
LINCOLN NE
68521-2425
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-8619
  • Fax: 402-476-8634
Mailing address:
  • Phone: 402-476-8619
  • Fax: 402-476-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEE N NOVOTNY
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 402-476-8619