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  5. BLACKSHEEP MEDICAL LLC

BLACKSHEEP MEDICAL LLC

Company Details

Entity Name: BLACKSHEEP MEDICAL LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 15 Aug 2013 (11 years ago)
Document Number: L13000115209
FEI/EIN Number 463419861
Address: 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174, US
Mail Address: 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174, US
ZIP code: 32174
County: Volusia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1770913360 2013-11-18 2013-11-18 1425 HAND AVE, SUITE L, ORMOND BEACH, FL, 321741135, US 1425 HAND AVE, SUITE L, ORMOND BEACH, FL, 321741135, US

Contacts
Phone +1 386-256-3977
Fax 3868725004

Authorized person
Name DANIEL A SEEDOR
Role MGMR
Phone 3862563977

Taxonomy
Taxonomy Code 261QH0100X - Health Service Clinic/Center
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BLACKSHEEP MEDICAL LLC 401(K) PLAN 2023 463419861 2024-07-29 BLACKSHEEP MEDICAL, LLC 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2016-01-01
Business code 621111
Sponsor’s telephone number 3862563977
Plan sponsor’s address 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174
BLACKSHEEP MEDICAL LLC 401(K) PLAN 2022 463419861 2023-09-15 BLACKSHEEP MEDICAL, LLC 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3862563977
Plan sponsor’s address 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174
BLACKSHEEP MEDICAL LLC 401(K) PLAN 2021 463419861 2022-08-05 BLACKSHEEP MEDICAL, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3862563977
Plan sponsor’s address 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2022-08-05
Name of individual signing DANIEL SEEDOR
Valid signature Filed with authorized/valid electronic signature
BLACKSHEEP MEDICAL LLC 401(K) PLAN 2020 463419861 2021-07-23 BLACKSHEEP MEDICAL, LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3862563977
Plan sponsor’s address 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2021-07-23
Name of individual signing DANIEL SEEDOR
Valid signature Filed with authorized/valid electronic signature
BLACKSHEEP MEDICAL LLC 401(K) PLAN 2019 463419861 2020-09-28 BLACKSHEEP MEDICAL, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2019-01-01
Business code 621111
Sponsor’s telephone number 3862563977
Plan sponsor’s address 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174

Signature of
Role Plan administrator
Date 2020-09-28
Name of individual signing DANIEL SEEDOR
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role
JOHN R. CHEWNING, DO, PA Agent

Managing Member

Name Role Address
CHEWNING JOHN R Managing Member 1425 HAND AVENUE, SUITE L, ORMOND BEACH, FL, 32174
SEEDOR DANIEL A Managing Member 1425 HAND AVENUE, ORMOND BEACH, FL, 32174

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J18000419150 TERMINATED 2018-30339-CICI CIRCUIT COURT, VOLUSIA COUNTY 2018-06-11 2023-06-22 $15,942.88 VANN DATA SERVICES, INC., 1801 DUNN AVENUE, DAYTONA BEACH FL 32114

Documents

Name Date
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-01-27
ANNUAL REPORT 2022-01-31
ANNUAL REPORT 2021-01-07
ANNUAL REPORT 2020-02-21
ANNUAL REPORT 2019-04-05
ANNUAL REPORT 2018-01-15
ANNUAL REPORT 2017-01-27
ANNUAL REPORT 2016-01-15
AMENDED ANNUAL REPORT 2015-09-05

Related by officers

CHEWNING JOHN R

BLACKSHEEP WELLNESS, LLC JOHN R. CHEWNING, DO, PA

SEEDOR DANIEL A

CHIROPRACTIC CONSULTANTS OF VOLUSIA, LLC

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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