MEDICARE: LAVALETTE CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	691	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00195054	OTHER	WV	MEDICARE RAILROAD CARRIER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1066162	OTHER	WV	WV WORKERS COMP VENDOR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	001720189	OTHER	WV	BLUE CROSS BLUE SHIELD ID
5	1841233806	OTHER	WV	NPI FOR JOHN FRY, DC

General Provider Information

NPI Number	:	1548349442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAVALETTE CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	PO BOX 1177
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-1177
Country	:	US
Telephone Number	:	304-522-7246
Fax Number	:	304-522-0018

Provider Business Practice Location Address
First Line	:	4600A ROUTE 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535
Country	:	US
Telephone Number	:	304-522-7246
Fax Number	:	304-522-0018

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN SAMUEL FRY
Credential	:	D.C.
Telephone Number	:	304-522-7246

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	06/21/2018

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Directions to “LAVALETTE CHIROPRACTIC INC ” Practice Location

Language	Start Address	Practice Location

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