| Entity Name: | TOTAL VITALITY HEALTH CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 23 Sep 2004 (20 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L04000069342 |
| FEI/EIN Number | 201649154 |
| Address: | 643 Cape Coral Pkwy East, SUITE E, CAPE CORAL, FL, 33904, US |
| Mail Address: | 643 Cape Coral Pkwy East, SUITE E, CAPE CORAL, FL, 33904, US |
| ZIP code: | 33904 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821252982 | 2008-07-17 | 2011-09-30 | 2717 SANTA BARBARA BLVD, # 8, CAPE CORAL, FL, 339144432, US | 2717 SANTA BARBARA BLVD, #8, CAPE CORAL, FL, 339144432, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-458-5747 |
| Fax | 2397728747 |
Authorized person
| Name | DR. KRISTINE KAY JOHNSON |
| Role | MANAGER |
| Phone | 2394585747 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH5548 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | BA793 |
| State | FL |
| Issuer | STATE LICENSE |
| Number | CH5548 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSON KRISTINE K | Agent | 643 Cape Coral Pkwy East, CAPE CORAL, FL, 33904 |
| Name | Role | Address |
|---|---|---|
| JOHNSON KRISTINE K | Manager | 643 Cape Coral Pkwy East, CAPE CORAL, FL, 33904 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-10 | 643 Cape Coral Pkwy East, SUITE E, CAPE CORAL, FL 33904 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-10 | 643 Cape Coral Pkwy East, SUITE E, CAPE CORAL, FL 33904 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-10 | 643 Cape Coral Pkwy East, SUITE E, CAPE CORAL, FL 33904 | No data |
| REINSTATEMENT | 2013-10-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-02-26 |
| ANNUAL REPORT | 2019-03-19 |
| ANNUAL REPORT | 2018-01-29 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-19 |
| ANNUAL REPORT | 2015-02-04 |
| ANNUAL REPORT | 2014-03-04 |
| REINSTATEMENT | 2013-10-08 |
| ANNUAL REPORT | 2012-01-07 |
| ANNUAL REPORT | 2011-02-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
