Colonics & Massage of Marianna, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

COLONICS & MASSAGE OF MARIANNA, LLC

Doing business as

Colonics & Massage Of Marianna, LLC

Practice address

2946 Jefferson St
Marianna, FL 32446-3140

Phone

(850) 526-3211

NPI assigned

Aug 10, 2021

Last updated

Aug 10, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Deloris A Brockner, RN, LMTNPI 1154094084

Title

Owner

Phone

(850) 526-3211

Specialties & licenses 1

Addresses

Other names 1

• Colonics & Massage Of Marianna, LLC Doing business as

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Deloris Ann Brockner, RN, LMT

  • Massage Therapist
  • Marianna, FL
  • NPI 1154094084
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1285309427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2946 JEFFERSON ST",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324463140",
            "telephone_number": "850-526-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2946 JEFFERSON ST",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324463140",
            "telephone_number": "850-526-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONICS & MASSAGE OF MARIANNA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "BROCKNER",
        "authorized_official_first_name": "DELORIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-526-3211",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, LMT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "PC",
            "affiliation": "N",
            "endpointDescription": "Apple",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "soap Notes",
            "address_1": "2946 Jefferson St",
            "city": "Marianna",
            "state": "FL",
            "country_code": "US",
            "postal_code": "324463140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Colonics & Massage Of Marianna, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Glenn L. Clark, M.D.
• Ellaretha Clemmons, LMHC
• Veronica Nichelle Coachman
• Fawantina Cockerham
• Kayce Cogswell, M.S. CCC-SLP
• Compassionate Care, LLC (Compassionate Care DME)
• Angelo Robert Consiglio, MD
• Larry J Cook
• April Renee Cooper, APRN
• Cordova Rehab Inc (Nursing Pavilion at Chipola Retirement Center)

• Clinic/Center in Marianna, FL
• Providers in Marianna, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.