Organization
CLEAN COLONIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN DEE BERRY (COLON HYDROTHERAPIST)
(480) 269-5575
Entity
Organization
Contact information
Practice address
7560 S. WILLOW DR, TEMPE, AZ 85283
(952) 994-3554
Mailing address
7560 S WILLOW DR, TEMPE, AZ 85283-5004
(480) 269-5575
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/14/2016
Last updated
01/19/2017
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