| Entity Name: | PROGRESSIVE CHIROPRACTIC AND REHABILITATION, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Mar 2014 (11 years ago) |
| Document Number: | L14000048543 |
| FEI/EIN Number | 46-5156432 |
| Address: | 502 S MAIN ST, CRESTVIEW, FL, 32536 |
| Mail Address: | 502 S MAIN ST, CRESTVIEW, FL, 32536, US |
| ZIP code: | 32536 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053730218 | 2014-04-15 | 2014-04-15 | 502 S MAIN ST, CRESTVIEW, FL, 325364250, US | 502 S MAIN ST, CRESTVIEW, FL, 325364250, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-398-8640 |
| Fax | 8503988641 |
Authorized person
| Name | DR. JOEL A. TATE |
| Role | CHIROPRACTIC PHYSICIAN/OWNER |
| Phone | 3098309694 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH9929 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | CH9929 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD PROVIDER NUMBER |
| Number | 220C0 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TATE JOEL AD.C. | Agent | 1428 Hickory St., NICEVILLE, FL, 32578 |
| Name | Role | Address |
|---|---|---|
| TATE LEANDRA P | Authorized Member | 1428 Hickory St., NICEVILLE, 32578 |
| TATE JOEL AD.C. | Authorized Member | 1428 Hickory St., NICEVILLE, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-07-18 | 1428 Hickory St., NICEVILLE, FL 32578 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-23 | 502 S MAIN ST, CRESTVIEW, FL 32536 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-03 |
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-07-18 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-04-05 |
| ANNUAL REPORT | 2017-01-23 |
| ANNUAL REPORT | 2016-03-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
