| Entity Name: | LAKE COUNTY SPINE & INJURY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Dec 2023 (a year ago) |
| Document Number: | L23000552336 |
| FEI/EIN Number | 99-0488510 |
| Address: | 128 N EUSTIS ST, EUSTIS, FL 32726 |
| Mail Address: | 128 N EUSTIS ST, EUSTIS, FL 32726 |
| ZIP code: | 32726 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699532671 | 2024-03-05 | 2024-03-05 | 128 N EUSTIS ST STE 101, EUSTIS, FL, 327263400, US | 128 N EUSTIS ST STE 101, EUSTIS, FL, 327263400, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 352-977-4824 |
Authorized person
| Name | IVI BIFSHA |
| Role | OWNER |
| Phone | 3529774824 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LTSC, LLC | Agent | 1901 W. COLONIAL DRIVE, ORLANDO, FL 32804 |
| Name | Role | Address |
|---|---|---|
| ANTHROS HEALTH PARTNERS TRUST | Manager | 128 N EUSTIS ST, EUSTIS, FL 32726 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| Florida Limited Liability | 2023-12-14 |
Date of last update: 08 Jan 2025
Sources: Florida Department of State
