| Entity Name: | EVANS CHIROPRACTIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 22 May 2009 (16 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: | L09000049946 |
| Address: | 3632 EVANS AVENUE, FT.MYERS, FL 33901 |
| Mail Address: | 1910 N.W.120 TERRACE, PEMBROKE PINES, FL 33926 |
| ZIP code: | 33901 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093944985 | 2009-07-13 | 2009-07-13 | 1910 NW 120TH TER, PEMBROKE PINES, FL, 330261944, US | 3632 EVANS AVE, FORT MYERS, FL, 339018314, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 954-441-7100 |
| Phone | +1 239-275-7246 |
Authorized person
| Name | DR. RICHARD BLUM |
| Role | OWNER |
| Phone | 9544417100 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| License Number | CH6210 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
| License Number | CH6210 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 380104700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLUM, RICHARD | Agent | 1910 N.W.120 TERRACE, PEMBROKE PINES, FL 33026 |
| Name | Role | Address |
|---|---|---|
| BLUM, RICHARD | Managing Member | 1910 N.W.120 TERRACE, PEMBROKE PINES, FL 33026 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2009-05-22 |
Date of last update: 25 Jan 2025
Sources: Florida Department of State
