| Entity Name: | ALL INJURY & DIAGNOSTIC CLINIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Dec 2018 (6 years ago) |
| Document Number: | L18000290286 |
| FEI/EIN Number | 832933244 |
| Address: | 125 MASON AVE, DAYTONA BEACH, FL, 32117, US |
| Mail Address: | 125 MASON AVE, DAYTONA BEACH, FL, 32117, US |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932672540 | 2019-01-07 | 2019-01-07 | 125 MASON AVE STE A, DAYTONA BEACH, FL, 321175017, US | 125 MASON AVE STE A, DAYTONA BEACH, FL, 321175017, US | |||||||||||||||||||||||||
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| Phone | +1 386-252-0658 |
| Fax | 3863130304 |
Authorized person
| Name | DR. JOHNATHAN LIVINGSTON WAGNER |
| Role | OWNER |
| Phone | 3862902324 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Taxonomy Code | 247100000X - Radiologic Technologist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | NPI TYPE 1 |
| Number | 1881628220 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOGUIDICE JOSEPH A | Agent | 1515A RIDGEWOOD AVE, HOLLY HILL, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| WAGNER JOHNATHAN | Manager | 125 MASON AVE, DAYTONA BEACH, FL, 32117 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-01-03 |
| ANNUAL REPORT | 2022-01-13 |
| ANNUAL REPORT | 2021-01-07 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-08 |
| Florida Limited Liability | 2018-12-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
