Healthcare Provider Details

I. General information

NPI: 1386561769
Provider Name (Legal Business Name): RIVERSIDE WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MAIN ST
GORHAM NH
03581-4900
US

IV. Provider business mailing address

630 MAIN ST
GORHAM NH
03581-4900
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-7727
  • Fax:
Mailing address:
  • Phone: 603-752-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL HANNA
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 563-726-1919