Provider Demographics
NPI:1265945786
Name:ELSASSER, SAMUEL TYLER (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:TYLER
Last Name:ELSASSER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 COPPERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3763
Mailing Address - Country:US
Mailing Address - Phone:402-203-3082
Mailing Address - Fax:
Practice Address - Street 1:2447 MILL CREEK CT STE 1
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8301
Practice Address - Country:US
Practice Address - Phone:850-325-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor