| Entity Name: | PRIME CARE INJURY CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 May 2021 (4 years ago) |
| Document Number: | L21000258624 |
| FEI/EIN Number | 87-0989484 |
| Address: | 5100 US HWY 98 North Suite 16, Lakeland, FL, 33809, US |
| Mail Address: | 5100 US HWY 98 North Suite 16, Lakeland, FL, 33809, US |
| ZIP code: | 33809 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750052262 | 2021-09-23 | 2021-09-23 | 5100 US HIGHWAY 98 N, LAKELAND, FL, 338090534, US | 5100 US HIGHWAY 98 N, LAKELAND, FL, 338090534, US | |||||||||||||
|
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| Phone | +1 863-859-5441 |
Authorized person
| Name | DR. ASRA KHAN |
| Role | CHIROPRACTOR |
| Phone | 8328147929 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Khan-Khaliq Asra U | Agent | 257 SUMMERSHORE DRIVE, AUBURNDALE, FL, 33823 |
| Name | Role | Address |
|---|---|---|
| ASRA UNNISA-KHAN KHALIQ | Manager | 257 SUMMERSHORE DRIVE, AUBURNDALE, FL, 33823 |
| Khaliq Rizwan A | Manager | 257 SUMMERSHORE DRIVE, AUBURNDALE, FL, 33823 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000076237 | OSTEON INJURY CENTER | ACTIVE | 2021-06-07 | 2026-12-31 | No data | 257 SUMMERSHORE DRIVE, AUBURNDALE, FL, 33823 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-27 | 5100 US HWY 98 North Suite 16, Lakeland, FL 33809 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-27 | 5100 US HWY 98 North Suite 16, Lakeland, FL 33809 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-27 | Khan-Khaliq, Asra Unnisa | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-27 |
| Florida Limited Liability | 2021-05-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
