| Entity Name: | PALM BAY CHIROPRACTIC AND WELLNESS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Jun 2022 (3 years ago) |
| Document Number: | L22000252780 |
| FEI/EIN Number | 88-2736295 |
| Address: | 490 CENTRE LAKE DRIVE NE, SUITE 100A, PALM BAY, FL, 32907, US |
| Mail Address: | 490 CENTRE LAKE DRIVE NE, SUITE 100A, PALM BAY, FL, 32907, US |
| ZIP code: | 32907 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780317040 | 2022-07-05 | 2022-11-21 | 490 CENTRE LAKE DR NE STE 100A, PALM BAY, FL, 329071113, US | 490 CENTRE LAKE DR NE STE 100A, PALM BAY, FL, 329071113, US | |||||||||||||||||||||
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| Phone | +1 321-499-4608 |
| Fax | 3214994607 |
Authorized person
| Name | DR. DAVID M. DURKIN |
| Role | CHIROPRACTIC PHYSICIAN |
| Phone | 3214994608 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CHIROPRACTIC LICENSE |
| Number | CH11572 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DURKIN DAVID M | Agent | 490 CENTRE LAKE DRIVE NE, PALM BAY, FL, 32907 |
| Name | Role | Address |
|---|---|---|
| DURKIN DAVID MDr. | Authorized Member | 20 BROOK CREST WAY, ORMOND BEACH, FL, 32174 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000071795 | MELBOURNE CHIROPRACTIC SPINE AND INJURY CENTER | ACTIVE | 2022-06-13 | 2027-12-31 | No data | 490 CENTRE LAKE DRIVE NE, SUITE 100A, PALM BAY, FL, 32907 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-13 |
| Florida Limited Liability | 2022-06-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
