| Entity Name: | RAYMOND D. CLITES, D.C., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 15 May 1987 (38 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 29 Mar 1991 (34 years ago) |
| Document Number: | J73166 |
| FEI/EIN Number | 59-2817543 |
| Address: | 134 N Moon Ave., BRANDON, FL 33510 |
| Mail Address: | 134 N Moon Ave., BRANDON, FL 33510 |
| ZIP code: | 33510 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790931277 | 2008-08-15 | 2014-01-27 | 134 N MOON AVE, BRANDON, FL, 335104420, US | 134 N MOON AVE, BRANDON, FL, 335104420, US | |||||||||||||||||||||||||
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| Phone | +1 813-684-1648 |
| Fax | 8136841748 |
Authorized person
| Name | DR. RAYMOND DALE CLITES |
| Role | DOCTOR/OWNER |
| Phone | 8136841648 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0004571 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 380271000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLITES, RAYMOND D. | Agent | 134 N Moon Ave., BRANDON, FL 33510 |
| Name | Role | Address |
|---|---|---|
| CLITES, RAYMOND D. | President | 134 N Moon Ave., BRANDON, FL 33510 |
| Name | Role | Address |
|---|---|---|
| CLITES, RAYMOND D. | Director | 134 N Moon Ave., BRANDON, FL 33510 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000073102 | RAYMOND D. CLITES, D.C., P.A. | ACTIVE | 2013-07-22 | 2028-12-31 | No data | 134 NORTH MOON AVE., BRANDON, FL. 33510, BRANDON, FL, 33510 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2015-04-07 | 134 N Moon Ave., BRANDON, FL 33510 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-09 | 134 N Moon Ave., BRANDON, FL 33510 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-09 | 134 N Moon Ave., BRANDON, FL 33510 | No data |
| NAME CHANGE AMENDMENT | 1991-03-29 | RAYMOND D. CLITES, D.C., P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-03-09 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-04-11 |
| ANNUAL REPORT | 2017-05-01 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-04-07 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
