Healthcare Provider Details

I. General information

NPI: 1356093686
Provider Name (Legal Business Name): BRETT CLASSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 REGENCY PKWY STE 104
OMAHA NE
68114-4301
US

IV. Provider business mailing address

120 REGENCY PKWY STE 104
OMAHA NE
68114-4301
US

V. Phone/Fax

Practice location:
  • Phone: 612-868-0146
  • Fax:
Mailing address:
  • Phone: 612-868-0146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHR.0008421
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHR.0008421
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2179
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: