Provider Demographics
NPI:1720887516
Name:HANNA, SAMUEL GLENN (DC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GLENN
Last Name:HANNA
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MITTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2627
Mailing Address - Country:US
Mailing Address - Phone:563-726-1919
Mailing Address - Fax:207-781-0060
Practice Address - Street 1:241 US ROUTE 1 STE 201
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-3201
Practice Address - Country:US
Practice Address - Phone:207-274-5933
Practice Address - Fax:207-781-0060
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR3097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor