=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497172415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANITE STATE CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2014
-----------------------------------------------------
Last Update Date | 03/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 84 HAYES RD
-----------------------------------------------------
City | LACONIA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03246-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-366-7337
-----------------------------------------------------
Fax | 603-366-5938
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 84 HAYES RD
-----------------------------------------------------
City | LACONIA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03246-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-366-7337
-----------------------------------------------------
Fax | 603-366-5938
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAMANTHA K RYAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 603-366-7337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 00203550380A
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------