Provider Demographics
NPI:1073723425
Name:BRADLEE N NOVOTNY, D.C., P.C.
Entity Type:Organization
Organization Name:BRADLEE N NOVOTNY, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NOVOTNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-476-8619
Mailing Address - Street 1:4401 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-2425
Mailing Address - Country:US
Mailing Address - Phone:402-476-8619
Mailing Address - Fax:402-476-8634
Practice Address - Street 1:4401 N 7TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-2425
Practice Address - Country:US
Practice Address - Phone:402-476-8619
Practice Address - Fax:402-476-8634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid
NE260913Medicare ID - Type Unspecified