Individual
DR. JOHN SAMUEL FRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
4600A ROUTE 152, LAVALETTE, WV 25535-9702
(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
—
1066162
WORKERS COMP VENDOR #
WV
01
—
52244677500
WORKERS COMP ID
WV
05
—
7600032000
—
WV
Enumeration date
06/14/2006
Last updated
07/09/2007
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