Individual
DR. ELYSSA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
2525 COMMERCIAL PARK DR, MARIANNA, FL 32448-2522
(850) 482-2373
Mailing address
2525 COMMERCIAL PARK DR, MARIANNA, FL 32448-2522
(850) 482-2373
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
2122
AL
111N00000X
Chiropractor
Primary
CH9060
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51527075
BCBS
AL
01
—
76131
BCBS
FL
Enumeration date
08/30/2006
Last updated
06/20/2019
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