| Entity Name: | SOUTH LAKE WELLNESS & INJURY CENTER, PL |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Apr 2004 (21 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 20 May 2004 (21 years ago) |
| Document Number: | L04000026047 |
| FEI/EIN Number | 200965743 |
| Address: | 2745 CITRUS TOWER BLVD, CLERMONT, FL, 34711, US |
| Mail Address: | 2745 CITRUS TOWER BLVD, CLERMONT, FL, 34711, US |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851579320 | 2008-02-06 | 2024-05-16 | 2745 CITRUS TOWER BLVD, CLERMONT, FL, 347116699, US | 2745 CITRUS TOWER BLVD, CLERMONT, FL, 347116699, US | |||||||||||||||||||
|
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| Phone | +1 352-241-4111 |
| Fax | 3522414113 |
Authorized person
| Name | MRS. MARY BETH BROCKMAN |
| Role | BILLING MANAGER |
| Phone | 3522414111 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0007823 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BROCKMAN PETER J | Agent | 2745 CITRUS TOWER BLVD, CLERMONT, FL, 34711 |
| Name | Role | Address |
|---|---|---|
| BROCKMAN PETER J | Managing Member | 13185 Lake Butler Blvd., Windermere, FL, 34786 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-08 | 2745 CITRUS TOWER BLVD, CLERMONT, FL 34711 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-11-26 | 2745 CITRUS TOWER BLVD, CLERMONT, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2018-11-26 | 2745 CITRUS TOWER BLVD, CLERMONT, FL 34711 | No data |
| AMENDMENT | 2004-05-20 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-01-05 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-03-16 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
