| Entity Name: | OVERLEA-FULLERTON CHIROPRACTIC CENTER, P.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: | Active |
| Date Filed: | 30 Aug 2004 (20 years ago) |
| Document Number: | F04000005048 |
| FEI/EIN Number | 521907464 |
| Address: | C/O DR. BRIAN AUGUSTINE, 5317 VILLAGE MARKET DR, WESLEY CHAPEL, FL, 33543, US |
| Mail Address: | C/O DR. BRIAN AUGUSTINE, 5317 VILLAGE MARKET DR, WESLEY CHAPEL, FL, 33543, US |
| ZIP code: | 33543 |
| County: | Pasco |
| Place of Formation: | MARYLAND |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780801761 | 2007-04-19 | 2010-10-20 | 5317 VILLAGE MARKET DRIVE, WESLEY CHAPEL, FL, 33544, US | 5317 VILLAGE MARKET DRIVE, WESLEY CHAPEL, FL, 33544, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-994-6008 |
| Fax | 8139943063 |
Authorized person
| Name | BRIAN J AUGUSTINE |
| Role | CHIROPRACTIC PHYSICIAN |
| Phone | 8139946008 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH006174 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | WELLCARE PRVD# |
| Number | 271773 |
| State | FL |
| Issuer | BCBS PRVD# |
| Number | 89273 |
| State | FL |
| Issuer | AVMED PRVD# |
| Number | 295986 |
| State | FL |
| Issuer | CHIRO ALLIANCE # |
| Number | 593466707 |
| State | FL |
| Issuer | STATE LICENSE # |
| Number | CH006174 |
| State | FL |
| Issuer | MEDICAID |
| Number | 381806300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BEARD ROBERT GJr. | Agent | 3432 HAWKS HILL TRL, TALLAHASSEE, FL, 32312 |
| Name | Role | Address |
|---|---|---|
| AUGUSTINE BRIAN JDr. | President | 5317 VILLAGE MARKET DR, WESLEY CHAPEL, FL, 33543 |
| Name | Role | Address |
|---|---|---|
| AUGUSTINE BRIAN JDr. | Secretary | 5317 VILLAGE MARKET DR, WESLEY CHAPEL, FL, 33543 |
| Name | Role | Address |
|---|---|---|
| AUGUSTINE BRIAN JDr. | Treasurer | 5317 VILLAGE MARKET DR, WESLEY CHAPEL, FL, 33543 |
| Name | Role | Address |
|---|---|---|
| AUGUSTINE BRIAN JDr. | Director | 5317 VILLAGE MARKET DR, WESLEY CHAPEL, FL, 33543 |
| BEARD ROBERT GJr. | Director | 3432 HAWKS HILL TRL, TALLAHASSEE, FL, 32312 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000064230 | AUGUSTINE CHIROPRACTIC | ACTIVE | 2013-06-25 | 2028-12-31 | No data | 3432 HAWKS HILL TRAIL, TALLAHASSEE, FL, 32312 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-15 | 3432 HAWKS HILL TRL, TALLAHASSEE, FL 32312 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-04-08 | BEARD, ROBERT G, Jr. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-02-20 | C/O DR. BRIAN AUGUSTINE, 5317 VILLAGE MARKET DR, WESLEY CHAPEL, FL 33543 | No data |
| CHANGE OF MAILING ADDRESS | 2010-02-20 | C/O DR. BRIAN AUGUSTINE, 5317 VILLAGE MARKET DR, WESLEY CHAPEL, FL 33543 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-03-04 |
| ANNUAL REPORT | 2022-03-01 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-01-24 |
| ANNUAL REPORT | 2019-02-16 |
| ANNUAL REPORT | 2018-02-02 |
| ANNUAL REPORT | 2017-02-24 |
| ANNUAL REPORT | 2016-02-18 |
| ANNUAL REPORT | 2015-01-31 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
