| Entity Name: | MAITLAND CHIROPRACTIC CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Jul 1983 (42 years ago) |
| Document Number: | G46072 |
| FEI/EIN Number | 592315789 |
| Address: | MAITLAND CHIROPRACTIC CLINIC, INC., 779 BEAR CREEK CIRCLE, WINTER SPRINGS, FL, 32708, US |
| Mail Address: | MAITLAND CHIROPRACTIC CLINIC, INC., 779 BEAR CREEK CIRCLE, WINTER SPRINGS, FL, 32708, US |
| ZIP code: | 32708 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023075181 | 2006-05-01 | 2008-07-07 | 500 S MAITLAND AVE, MAITLAND, FL, 327515622, US | 500 S MAITLAND AVE, MAITLAND, FL, 327515622, US | |||||||||||||||||||||||||
|
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| Phone | +1 407-628-9999 |
| Fax | 4076282917 |
Authorized person
| Name | MISS CHRISTIANNE MICHELLE DUVAL |
| Role | VICE PRESIDENT |
| Phone | 4076289999 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | HCC6175 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 3817849 00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DUVAL JANE L | Agent | MAITLAND CHIROPRACTIC CLINIC, INC., WINTER SPRINGS, FL, 32708 |
| Name | Role | Address |
|---|---|---|
| DUVAL, JANE L. | President | 779 BEAR CREEK CIRCLE, WINTER SPRINGS, FL, 32708 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000043784 | VITALITY DAY SPA | EXPIRED | 2012-06-29 | 2017-12-31 | No data | 500 SOUTH MAITLAND AVENUE, MAITLAND, FL, 32751 |
| G09000180747 | MAITLAND CLINIC | EXPIRED | 2009-12-03 | 2014-12-31 | No data | 500 SOUTH MAITLAND AVENUE, MAITLAND, FL, 32751 |
| G08080900263 | VITALITY WELLNESS | EXPIRED | 2008-03-20 | 2013-12-31 | No data | 500 SOUTH MAITLAND AVENUE, MAITLAND, FL, 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-04-30 | No data | No data |
| NAME CHANGE AMENDMENT | 2003-10-03 | MAITLAND CHIROPRACTIC CLINIC, INC. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
