Organization
LAVALETTE CHIROPRACTIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN SAMUEL FRY D.C. (PRESIDENT)
(304) 522-7246
Entity
Organization
Contact information
Practice address
4600A ROUTE 152, LAVALETTE, WV 25535
(304) 522-7246
(304) 522-0018
Mailing address
PO BOX 1177, LAVALETTE, WV 25535-1177
(304) 522-7246
(304) 522-0018
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
691
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720189
BLUE CROSS BLUE SHIELD ID
WV
01
—
1066162
WV WORKERS COMP VENDOR
WV
01
—
1841233806
NPI FOR JOHN FRY, DC
WV
05
—
7600032000
—
WV
01
—
P00195054
MEDICARE RAILROAD CARRIER
WV
Enumeration date
11/03/2006
Last updated
06/21/2018
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