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General NPI Number Information
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NPI Number | 1336068527
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Entity Type | Organization
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Legal Business Name | CEREDO CHIROPRACTIC & INTEGRATED WELLNESS PLLC
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 420 W 4TH ST STE 10A
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City | CEREDO
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State | WV
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Zip | 25507-2125
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Country | US
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Telephone | 657-640-9199
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1208
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City | CEREDO
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State | WV
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Zip | 25507-1208
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Country | US
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Telephone | 657-640-9199
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN SAMUEL FRY
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Credential | DC
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Telephone | 304-544-2239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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