Provider Demographics
NPI:1730616814
Name:PALLY, ELISSA LEE (DC)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:LEE
Last Name:PALLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10930 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4701
Mailing Address - Country:US
Mailing Address - Phone:813-884-1457
Mailing Address - Fax:813-884-1528
Practice Address - Street 1:10930 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4701
Practice Address - Country:US
Practice Address - Phone:813-884-1457
Practice Address - Fax:813-884-1528
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12193111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor