Healthcare Provider Details

I. General information

NPI: 1689209769
Provider Name (Legal Business Name): LINCOLN JOINT & WELLNESS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 05/18/2022
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S 70TH ST STE 117
LINCOLN NE
68516-4283
US

IV. Provider business mailing address

4500 S 70TH ST STE 117
LINCOLN NE
68516-4283
US

V. Phone/Fax

Practice location:
  • Phone: 402-235-4701
  • Fax: 402-296-8614
Mailing address:
  • Phone: 402-235-4701
  • Fax: 402-296-8614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVE SELF
Title or Position: OWNER
Credential:
Phone: 402-235-4701