| Entity Name: | PORT ST. JOE CHIROPRACTIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Sep 2004 (20 years ago) |
| Document Number: | L04000069032 |
| FEI/EIN Number | 371495585 |
| Address: | 1605 Renaissance Common Blvd, Boynton Beach, FL, 33426, US |
| Mail Address: | 22038 North Acapulco Drive, Sun City West, AZ, 85375, US |
| ZIP code: | 33426 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497928121 | 2008-04-02 | 2014-06-12 | 16910 S US HIGHWAY 441, SUMMERFIELD, FL, 344918664, US | 16910 S US HIGHWAY 441, SUMMERFIELD, FL, 344918664, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-960-8118 |
| Fax | 3523479044 |
Authorized person
| Name | DOUGLAS ALTMAN |
| Role | OWNER/CHIROPRACTOR |
| Phone | 8509608118 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UPIN |
| Number | U85018 |
| State | FL |
| Issuer | BCBS |
| Number | 88546 |
| Issuer | MEDICAID |
| Number | 381798900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Altman Douglas | Agent | 1605 Renaissance Commons Blvd, Boynton Beach, FL, 33426 |
| Name | Role | Address |
|---|---|---|
| ALTMAN DOUGLAS | Managing Member | 1605 Renaissance Commons Blvd, Boynton Beach, FL, 33426 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-04-30 | 1605 Renaissance Common Blvd, 236, Boynton Beach, FL 33426 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-14 | 1605 Renaissance Common Blvd, 236, Boynton Beach, FL 33426 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-03-14 | Altman, Douglas | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-14 | 1605 Renaissance Commons Blvd, 236, Boynton Beach, FL 33426 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-30 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-05-22 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-06-13 |
| ANNUAL REPORT | 2018-03-14 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
