| Entity Name: | POWER SPINE & PAIN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Oct 2023 (a year ago) |
| Document Number: | L23000482973 |
| Address: | 308 KINGSLEY LAKE DR, SUITE 802 & 803, SAINT AUGUSTINE, FL, 32092, US |
| Mail Address: | 308 KINGSLEY LAKE DR, SUITE 802, SAINT AUGUSTINE, FL, 32092, US |
| ZIP code: | 32092 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558133694 | 2023-10-23 | 2024-03-18 | 308 KINGSLEY LAKE DR STE 802, SAINT AUGUSTINE, FL, 320923046, US | 308 KINGSLEY LAKE DR STE 802, SAINT AUGUSTINE, FL, 320923046, US | |||||||||||||||
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| Phone | +1 904-342-0438 |
| Fax | 9043420498 |
Authorized person
| Name | MICHAEL DEVEAU |
| Role | PRESIDENT |
| Phone | 9043420438 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DEVEAU MICHAEL | Agent | 11764 MARCO BEACH DR., JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| DEVEAU MICHAEL | Manager | 308 KINGSLEY LAKE DR, SAINT AUGUSTINE, FL, 32092 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000067014 | POWER SPINE | ACTIVE | 2024-05-26 | 2029-12-31 | No data | 308 KINGSLEY LAKE DR., SUITE 802, ST AUGUSTINE, FL, 32092 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-26 | 308 KINGSLEY LAKE DR, SUITE 802 & 803, SAINT AUGUSTINE, FL 32092 | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2023-10-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
