| Entity Name: | CENTRAL FLORIDA INTEGRATED WELLNESS CLINIC, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 01 Jun 2011 (14 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L11000064258 |
| FEI/EIN Number | 452446411 |
| Address: | 500 E. HORATIO AVENUE, SUITE 5, MAITLAND, FL, 32751, US |
| Mail Address: | 500 E. HORATIO AVENUE, SUITE 5, MAITLAND, FL, 32751, US |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265727861 | 2011-06-13 | 2011-06-13 | 500 E HORATIO AVE, SUITE 5, MAITLAND, FL, 327517310, US | 500 E HORATIO AVE, SUITE 5, MAITLAND, FL, 327517310, US | |||||||||||||||||||||||||||
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| Phone | +1 407-629-5333 |
| Fax | 4076295343 |
Authorized person
| Name | DR. CHANNING C. BOLICK |
| Role | MGR |
| Phone | 4076295333 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH7882 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| License Number | ME45785 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BOLICK CHANNING C | Agent | 500 E. HORATIO AVE, MAITLAND, FL, 32751 |
| Name | Role | Address |
|---|---|---|
| BOLICK CHANNING C | Manager | 500 E. HORATIO AVE, SUITE 5, MAITLAND, FL, 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-26 |
| ANNUAL REPORT | 2015-01-26 |
| ANNUAL REPORT | 2014-03-11 |
| ANNUAL REPORT | 2013-02-20 |
| ANNUAL REPORT | 2012-04-21 |
| Florida Limited Liability | 2011-06-01 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
