Organization
ELYSSA N WALLER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELYSSA WALLER DC (OWNER)
(850) 482-2373
Entity
Organization
Contact information
Practice address
4729 HIGHWAY 90, MARIANNA, FL 32446-6820
(850) 482-2373
(850) 482-2395
Mailing address
4729 HIGHWAY 90, MARIANNA, FL 32446-6820
(850) 482-2373
(850) 482-2395
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH9060
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U1XD4
FLORIDA BLUE
—
Enumeration date
12/29/2016
Last updated
12/29/2016
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