Healthcare Provider Details

I. General information

NPI: 1720887516
Provider Name (Legal Business Name): SAMUEL GLENN HANNA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
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: 844-951-2494
Mailing address:
  • Phone: 603-752-7727
  • Fax: 844-951-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCR3097
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: