| Entity Name: | DYNAMIC MEDICAL REHABILITATION CENTER OF DEERFIELD BEACH, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 15 Jul 2005 (20 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L05000069765 |
| FEI/EIN Number | 203240842 |
| Address: | 342 SOUTH POWERLINE RD., DEERFIELD BEACH, FL, 33442 |
| Mail Address: | 342 SOUTH POWERLINE RD., DEERFIELD BEACH, FL, 33442 |
| ZIP code: | 33442 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407073299 | 2007-04-20 | 2020-08-22 | 342 S POWERLINE RD, DEERFIELD BEACH, FL, 334428105, US | 342 S POWERLINE RD, DEERFIELD BEACH, FL, 334428105, US | |||||||||||||||||||||||||
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| Phone | +1 954-421-2005 |
| Fax | 9544214285 |
Authorized person
| Name | DR. MICHAEL R BASTKOWSKI |
| Role | PRESIDENT |
| Phone | 9544212005 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH7166 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 77325A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BASTKOWSKI MICHAEL | Agent | 2489 LOB LOLLY LANE, DEERFIELD BEACH, FL, 33442 |
| Name | Role | Address |
|---|---|---|
| BASTKOWSKI MICHAEL | Managing Member | 2489 LOB LOLLY LANE, DEERFIELD BEACH, FL, 33442 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REINSTATEMENT | 2010-06-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-05-04 | 342 SOUTH POWERLINE RD., DEERFIELD BEACH, FL 33442 | No data |
| CHANGE OF MAILING ADDRESS | 2006-05-04 | 342 SOUTH POWERLINE RD., DEERFIELD BEACH, FL 33442 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2010-06-30 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-03-19 |
| ANNUAL REPORT | 2006-05-01 |
| Florida Limited Liability | 2005-07-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
