| Entity Name: | INTEGRATED SPORTS AND SPINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 19 Oct 2004 (20 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | L04000075763 |
| FEI/EIN Number | 20-1711655 |
| Address: | 9623 ROYCE DR., TAMPA, FL 33626 |
| Mail Address: | 9623 ROYCE DR., TAMPA, FL 33626 |
| ZIP code: | 33626 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629249909 | 2008-03-14 | 2008-03-14 | 2905 RIGSBY LN, SAFETY HARBOR, FL, 346954828, US | 2905 RIGSBY LN, SAFETY HARBOR, FL, 346954828, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 727-797-0500 |
| Fax | 7277970050 |
Authorized person
| Name | DR. DAMON STAFFORD |
| Role | OWNER |
| Phone | 7277970500 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH8146 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME97457 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE |
| Number | CH8146 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRIAN PRZYSTUP AND ASSOCIATES LLC | Agent | 275 NE 18TH ST, #310, MIAMI, FL 33132 |
| Name | Role | Address |
|---|---|---|
| STAFFORD, DAMON J | Manager | 9623 ROYCE DRIVE, TAMPA, FL 33626 |
| Name | Role | Address |
|---|---|---|
| RHODES, RICHARD D | Managing Member | 8813 GRAND BAYOU CT, TAMPA, FL 33635 |
| GROTEKE, ERIC K | Managing Member | 3048 GLENWOOD CT, SAFTY HARBOR, FL 34695 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08190900343 | NORTHWOOD SURGERY CENTER | EXPIRED | 2008-07-08 | 2013-12-31 | No data | 3001 EASTLAND BLVD., BLDG. G STE.#2, CLEARWATER, FL, 33761 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2008-12-10 | BRIAN PRZYSTUP AND ASSOCIATES LLC | No data |
| CANCEL ADM DISS/REV | 2008-12-10 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-12-10 | 275 NE 18TH ST, #310, MIAMI, FL 33132 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| LC AMENDMENT AND NAME CHANGE | 2008-02-19 | INTEGRATED SPORTS AND SPINE, LLC | No data |
| CHANGE OF MAILING ADDRESS | 2007-04-25 | 9623 ROYCE DR., TAMPA, FL 33626 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-04-25 | 9623 ROYCE DR., TAMPA, FL 33626 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-04-30 |
| REINSTATEMENT | 2008-12-10 |
| LC Amendment and Name Change | 2008-02-19 |
| ANNUAL REPORT | 2007-04-25 |
| ANNUAL REPORT | 2006-03-30 |
| ANNUAL REPORT | 2005-04-11 |
| Florida Limited Liability | 2004-10-19 |
Date of last update: 05 Jan 2025
Sources: Florida Department of State
