MEDICARE: DR. JOHN SAMUEL FRY D.C.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1066162	OTHER	WV	WORKERS COMP VENDOR #
2	52244677500	OTHER	WV	WORKERS COMP ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841233806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SAMUEL FRY D.C.

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	:	25535-9702
Country	:	US
Telephone Number	:	304-522-7246
Fax Number	:	304-522-0018

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/09/2007

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