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SPINAL SOLUTIONS HEALTH AND WELLNESS, PLLC - Florida Company Profile

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Company Details

Entity Name: SPINAL SOLUTIONS HEALTH AND WELLNESS, PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 23 Mar 2021 (4 years ago)
Document Number: L21000136747
FEI/EIN Number 85-3782185
Address: 276 PASEO REYES DRIVE, ST AUGUSTINE, FL, 32095, US
Mail Address: 200 FRONT DOOR LANE, ST AUGUSTINE, FL, 32095, US
ZIP code: 32095
City: Saint Augustine
County: St. Johns
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
SISAK DEREK JDC Manager 200 FRONT DOOR LANE, ST AUGUSTINE, FL, 32095
Reynolds Dawn Agent 200 Front Door Lane, St Augustine, FL, 32095

National Provider Identifier

NPI Number:
1083297915
Certification Date:
2021-05-31

Authorized Person:

Name:
DR. DEREK SISAK
Role:
CHIROPRACTOR
Phone:

Taxonomy:

Selected Taxonomy:
111N00000X - Chiropractor
Is Primary:
Yes

Contacts:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000027402 LUMOS ACTIVE 2023-02-28 2028-12-31 - 276 PASEO REYES DRIVE, ST AUGUSTINE, FL, 32095

Events

Event Type Filed Date Value Description
REGISTERED AGENT NAME CHANGED 2023-02-17 Reynolds, Dawn -
REGISTERED AGENT ADDRESS CHANGED 2023-02-17 200 Front Door Lane, St Augustine, FL 32095 -

Documents

Name Date
ANNUAL REPORT 2025-02-04
ANNUAL REPORT 2024-02-06
ANNUAL REPORT 2023-02-17
ANNUAL REPORT 2022-01-22
Florida Limited Liability 2021-03-23

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Date of last update: 03 Aug 2025

Sources: Florida Department of State