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General NPI Number Information
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NPI Number | 1689209769
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Entity Type | Organization
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Legal Business Name | LINCOLN JOINT & WELLNESS CARE
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 4500 S 70TH ST STE 117
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City | LINCOLN
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State | NE
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Zip | 68516-4283
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Country | US
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Telephone | 402-235-4701
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Fax | 402-296-8614
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Provider Business Mailing Address
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Address Line | 4500 S 70TH ST STE 117
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City | LINCOLN
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State | NE
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Zip | 68516-4283
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Country | US
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Telephone | 402-235-4701
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Fax | 402-296-8614
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVE SELF
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Credential |
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Telephone | 402-235-4701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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