| Entity Name: | COASTLINE SPINE & HEALTH CENTER VERO LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 13 Mar 2024 (a year ago) |
| Document Number: | L24000126004 |
| FEI/EIN Number | 99-2357251 |
| Address: | 974 14TH LANE, VERO BEACH, FL 32960 |
| Mail Address: | 974 14TH LANE, VERO BEACH, FL 32960 |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396563235 | 2024-09-30 | 2024-09-30 | 974 14TH LN, VERO BEACH, FL, 329604734, US | 974 14TH LN, VERO BEACH, FL, 329604734, US | |||||||||||||
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| Phone | +1 484-707-2385 |
Authorized person
| Name | DR. KEITH HURLEY |
| Role | AO, PROVIDER OWNER |
| Phone | 4847072385 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HURLEY, KEITH R, DR. | Agent | 2054 Bottlebrush Drive, MELBOURNE, FL 32935 |
| Name | Role | Address |
|---|---|---|
| HURLEY, KEITH R, DR. | Authorized Person | 2054 Bottlebrush Drive, MELBOURNE, FL 32935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-02-08 | 974 14TH LANE, VERO BEACH, FL 32960 | No data |
| CHANGE OF MAILING ADDRESS | 2025-02-08 | 974 14TH LANE, VERO BEACH, FL 32960 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-02-08 | 2054 Bottlebrush Drive, MELBOURNE, FL 32935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-08 |
| Florida Limited Liability | 2024-03-13 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
