| Entity Name: | PRIME CARE CHIROPRACTIC CENTERS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Jul 1976 (49 years ago) |
| Document Number: | 507039 |
| FEI/EIN Number | 591680638 |
| Address: | 1400 HAVENDALE BLVD., WINTER HAVEN, FL, 33881 |
| Mail Address: | 1400 HAVENDALE BLVD., WINTER HAVEN, FL, 33881 |
| ZIP code: | 33881 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982889523 | 2008-01-02 | 2008-01-29 | 1400 HAVENDALE BLVD NW, WINTER HAVEN, FL, 338815302, US | 1400 HAVENDALE BLVD NW, WINTER HAVEN, FL, 338815302, US | |||||||||||||||||||||||||||||||
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| Phone | +1 863-294-3109 |
| Fax | 8632930078 |
Authorized person
| Name | DR. DAVID RILEY THOMSEN |
| Role | PRESIDENT |
| Phone | 8632943109 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH7537 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 55721 |
| State | FL |
| Issuer | UNITED HEALTH CARE |
| Number | 628545 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THOMSEN DAVID R | Agent | 1400 HAVENDALE BLVD, WINTER HAVEN, FL, 33881 |
| Name | Role | Address |
|---|---|---|
| THOMSEN DAVID | President | 2427 WILDWOOD CT, WINTER HAVEN, FL, 33884 |
| Name | Role | Address |
|---|---|---|
| THOMSEN DAVID | Director | 2427 WILDWOOD CT, WINTER HAVEN, FL, 33884 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G01232900378 | PRIME CARE CHIROPRACTIC CENTERS, P.A. | ACTIVE | 2001-08-21 | 2026-12-31 | No data | 1400 HAVENDALE BLVD, WINTER HAVEN, FL, 33881 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2002-12-09 | PRIME CARE CHIROPRACTIC CENTERS, P.A. | No data |
| NAME CHANGE AMENDMENT | 2001-09-21 | HENDRICKS CHIROPRACTIC OFFICE, P.A./PRIME CARE CHIROPRACTIC CENTERS, P.A. | No data |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
