| Entity Name: | DAVID L. FRERKING, D.C., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 May 1985 (40 years ago) |
| Document Number: | H59533 |
| FEI/EIN Number | 592565384 |
| Address: | 915 E ALFRED ST, TAVARES, FL, 32778 |
| Mail Address: | 915 E ALFRED ST, TAVARES, FL, 32778 |
| ZIP code: | 32778 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265732234 | 2010-10-25 | 2011-03-09 | 915 E ALFRED ST, TAVARES, FL, 327783401, US | 915 E ALFRED ST, TAVARES, FL, 327783401, US | |||||||||||||||||||||||||
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| Phone | +1 352-343-9275 |
| Fax | 3523434646 |
Authorized person
| Name | MR. DAVID LEWIS FRERKING |
| Role | OWNER |
| Phone | 3523439275 |
Taxonomy
| Taxonomy Code | 111NI0900X - Internist Chiropractor |
| License Number | CH3705 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0501522-00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FRERKING, DAVID L. | Agent | 915 E ALFRED ST, TAVARES, FL, 32778 |
| Name | Role | Address |
|---|---|---|
| FRERKING, DAVID L. | President | 915 E ALFRED ST, TAVARES, FL |
| FRERKING ANNETTE | President | 30825 CYPRESS DR, TAVARES, FL, 32778 |
| Name | Role | Address |
|---|---|---|
| FRERKING, DAVID L. | Secretary | 915 E ALFRED ST, TAVARES, FL |
| Name | Role | Address |
|---|---|---|
| FRERKING, DAVID L. | Treasurer | 915 E ALFRED ST, TAVARES, FL |
| Name | Role | Address |
|---|---|---|
| FRERKING ANNETTE | Vice President | 30825 CYPRESS DR, TAVARES, FL, 32778 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000073829 | TAVARES FAMILY CHIROPRACTIC | EXPIRED | 2019-07-05 | 2024-12-31 | No data | 915 E ALFRED STREET, TAVARES, FL, 32778 |
| G13000113392 | TAVARES HEALTH AND WELLNESS CENTER | EXPIRED | 2013-11-08 | 2018-12-31 | No data | 915 E. ALFRED ST., TAVARES, FL, 32778 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
