| Entity Name: | INTEGRITY SPORT AND SPINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Aug 2023 (a year ago) |
| Document Number: | L23000390630 |
| FEI/EIN Number | 93-3076782 |
| Address: | 2445 Country Place Blvd, NEW PORT RICHEY, FL, 34655, US |
| Mail Address: | 2445 Country Place Blvd, NEW PORT RICHEY, FL, 34655, US |
| ZIP code: | 34655 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386424059 | 2023-10-02 | 2023-12-08 | 2445 COUNTRY PLACE BLVD STE 103, NEW PORT RICHEY, FL, 346551102, US | 2445 COUNTRY PLACE BLVD STE 103, NEW PORT RICHEY, FL, 346551102, US | |||||||||||||||||||||||
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| Phone | +1 727-264-6091 |
| Fax | 7272646099 |
| Phone | +1 727-372-9500 |
Authorized person
| Name | DR. AMBER LYNN KOLLEN |
| Role | OWNER/CHIROPRACTOR |
| Phone | 7272646091 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PERSONAL NPI |
| Number | 1962042093 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KOLLEN AMBER L | Agent | 2842 GRIDIRON ISLE, NEW PORT RICHEY, FL, 34655 |
| Name | Role | Address |
|---|---|---|
| KOLLEN AMBER L | Manager | 2842 GRIDIRON ISLE, NEW PORT RICHEY, FL, 34655 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-08 | 2445 Country Place Blvd, Ste 103, NEW PORT RICHEY, FL 34655 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-08 | 2445 Country Place Blvd, Ste 103, NEW PORT RICHEY, FL 34655 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-16 |
| Florida Limited Liability | 2023-08-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
