Elyssa Waller, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH9060 Issued in FL

Practice address

2525 Commercial Park Dr
Marianna, FL 32448-2522

Phone

(850) 482-2373

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elyssa N Waller

  • Chiropractor
  • Marianna, FL
  • NPI 1962947960
  NPD (past) Authorized official
• Back and Neck Pain Clinic, LLC

  • Chiropractor
  • Dothan, AL
  • NPI 1841476926
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1265541536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 COMMERCIAL PARK DR",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324482522",
            "telephone_number": "850-482-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 COMMERCIAL PARK DR",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324482522",
            "telephone_number": "850-482-2373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4729 Hwy 90",
            "address_purpose": "LOCATION",
            "city": "Marianna",
            "state": "FL",
            "postal_code": "32446",
            "country_code": "US",
            "telephone_number": "850-482-2373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "ELYSSA",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AL",
            "license": "2122",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH9060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "76131",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51527075",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Wadsworth, LMHC
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• Danielle L Walker, PA-C
• Mary Monica Watkins-Clay, PH.D.
• Watson DS, Inc. (WATSON MEDEquip Store)
• Jimmy Watts
• Angelica Webb
• Wensi Natasha West, L.M.T.

• Chiropractor in Marianna, FL
• Providers in Marianna, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.