| Entity Name: | RADIANT HEALTH CHIROPRACTIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Nov 2011 (13 years ago) |
| Document Number: | L11000131134 |
| FEI/EIN Number | 45-3832166 |
| Address: | 209 DUNLAWTON AVE, PORT ORANGE, FL, 32127, US |
| Mail Address: | 209 DUNLAWTON AVE, PORT ORANGE, FL, 32127, US |
| ZIP code: | 32127 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184991127 | 2011-11-18 | 2021-08-23 | 209 DUNLAWTON AVE STE 18, PORT ORANGE, FL, 321274458, US | 209 DUNLAWTON AVE STE 18, PORT ORANGE, FL, 321274458, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 386-308-9076 |
| Fax | 3866756591 |
Authorized person
| Name | BRANDON LAVELLE |
| Role | CHIROPRACTOR |
| Phone | 3863089076 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH9993 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 007930500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAVELLE BRANDON W | Agent | 596 Touchstone Circle, PORT ORANGE, FL, 32127 |
| Name | Role | Address |
|---|---|---|
| LAVELLE BRANDON W | Managing Member | 596 Touchstone Circle, PORT ORANGE, FL, 32127 |
| LAVELLE TASHA L | Managing Member | 596 Touchstone Circle, PORT ORANGE, FL, 32127 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-22 | 209 DUNLAWTON AVE, SUITE 18, PORT ORANGE, FL 32127 | No data |
| CHANGE OF MAILING ADDRESS | 2021-02-22 | 209 DUNLAWTON AVE, SUITE 18, PORT ORANGE, FL 32127 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-03-26 | 596 Touchstone Circle, PORT ORANGE, FL 32127 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-07 |
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-01-10 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-02-22 |
| ANNUAL REPORT | 2020-03-27 |
| ANNUAL REPORT | 2019-01-10 |
| ANNUAL REPORT | 2018-02-19 |
| ANNUAL REPORT | 2017-02-02 |
| ANNUAL REPORT | 2016-03-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
