Provider Demographics
NPI:1689209769
Name:LINCOLN JOINT & WELLNESS CARE
Entity type:Organization
Organization Name:LINCOLN JOINT & WELLNESS CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-235-4701
Mailing Address - Street 1:4500 S 70TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4283
Mailing Address - Country:US
Mailing Address - Phone:402-235-4701
Mailing Address - Fax:402-296-8614
Practice Address - Street 1:4500 S 70TH ST STE 117
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4283
Practice Address - Country:US
Practice Address - Phone:402-235-4701
Practice Address - Fax:402-296-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies