Organization
COLONICS & MASSAGE OF MARIANNA, LLC
Active
Other names
Colonics & Massage Of Marianna, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DELORIS A BROCKNER RN, LMT (OWNER)
(850) 526-3211
Entity
Organization
Contact information
Practice address
2946 JEFFERSON ST, MARIANNA, FL 32446-3140
(850) 526-3211
Mailing address
2946 JEFFERSON ST, MARIANNA, FL 32446-3140
(850) 526-3211
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA90046
MASSAGE THERAPY
FL
Enumeration date
08/10/2021
Last updated
08/10/2021
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