| Entity Name: | FORT CAROLINE CLINIC OF CHIROPRACTIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Jul 2021 (4 years ago) |
| Document Number: | L21000304653 |
| FEI/EIN Number | 87-1491895 |
| Address: | 12086 Fort Caroline Rd. Ste 302, jacksonville, FL, 32225, US |
| Mail Address: | 14097 PINE ISLAND DR, JACKSONVILLE, FL, 32224 |
| ZIP code: | 32225 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710648746 | 2022-01-03 | 2022-01-03 | 14097 PINE ISLAND DR, JACKSONVILLE, FL, 322243110, US | 12086 FORT CAROLINE RD STE 302, JACKSONVILLE, FL, 322257639, US | |||||||||||||||
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| Phone | +1 814-590-4411 |
| Phone | +1 904-902-4325 |
Authorized person
| Name | DR. JEREMY E BRUBAKER |
| Role | MEMBER |
| Phone | 9044198898 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BRUBAKER JEREMY E | Agent | 14097 PINE ISLAND DR, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| BRUBAKER JEREMY E | Manager | 14097 PINE ISLAND DR, JACKSONVILLE, FL, 32224 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000016339 | RIVER BEND CLINIC | ACTIVE | 2022-02-08 | 2027-12-31 | No data | 12086 FORT CAROLINE RD., STE 302, JACKSONVILLE, FL, 32225 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-10 | 12086 Fort Caroline Rd. Ste 302, jacksonville, FL 32225 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-03-10 |
| Florida Limited Liability | 2021-07-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
