| Entity Name: | WIEDNER FAMILY CHIROPRACTIC, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 May 2018 (7 years ago) |
| Document Number: | L18000129484 |
| FEI/EIN Number | 83-0673168 |
| Address: | 1411 SOUTH EAST OCEAN BOULEVARD, STUART, FL, 34996, US |
| Mail Address: | 1411 SOUTH EAST OCEAN BOULEVARD, STUART, FL, 34996, US |
| ZIP code: | 34996 |
| County: | Martin |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871968032 | 2015-12-14 | 2015-12-14 | 931 SE OCEAN BLVD STE C, STUART, FL, 349942425, US | 931 SE OCEAN BLVD STE C, STUART, FL, 349942425, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 772-781-1101 |
| Fax | 7727811141 |
Authorized person
| Name | MS. OLGA VEIGA |
| Role | INSURANCE |
| Phone | 7727811101 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | CH7269 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| License Number | CH7269 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE PTAN |
| Number | 350041521 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | 55523 |
| State | FL |
| Issuer | BLUE CROSS / BLUE SHIELD PTAN |
| Number | 55523 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WIEDNER WILLIAM J | Agent | 130 SE ALAMANDA WAY, STUART, FL, 34996 |
| Name | Role | Address |
|---|---|---|
| WIEDNER WILLIAM J | Manager | 1411 SOUTH EAST OCEAN BOULEVARD, STUART, FL, 34996 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000062562 | WIEDNER WELLNESS SOLUTIONS | EXPIRED | 2018-05-25 | 2023-12-31 | No data | 931 EAST OCEAN BOULEVARD, STUART, FL, 34994 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-07 | 1411 SOUTH EAST OCEAN BOULEVARD, STUART, FL 34996 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-07 | 1411 SOUTH EAST OCEAN BOULEVARD, STUART, FL 34996 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-04-03 |
| ANNUAL REPORT | 2021-04-03 |
| ANNUAL REPORT | 2020-06-07 |
| ANNUAL REPORT | 2019-04-12 |
| Florida Limited Liability | 2018-05-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
