| Entity Name: | COMPLETE WELLNESS CHIROPRACTIC CENTER OF DELAND, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 21 Aug 2024 (6 months ago) |
| Document Number: | L24000366975 |
| Address: | 844 N. STONE STREET, SUITE 202, DELAND, FL 32720 |
| Mail Address: | 844 N. STONE STREET, SUITE 202, DELAND, FL 32720 |
| ZIP code: | 32720 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134249618 | 2007-03-30 | 2024-09-09 | 844 N STONE ST, SUIT 202, DELAND, FL, 327203208, US | 844 N STONE ST, SUIT 202, DELAND, FL, 327203208, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-734-2592 |
| Fax | 3867341773 |
Authorized person
| Name | J RANDALL TIMKO |
| Role | OWNER |
| Phone | 3867342592 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH8909 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH10693 |
| Is Primary | No |
| Taxonomy Code | 111NX0800X - Orthopedic Chiropractor |
| License Number | CH4523 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT16948 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225700000X - Massage Therapist |
| License Number | MA36547 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BCBS GROUP# |
| Number | 21330 |
| State | FL |
| Name | Role |
|---|---|
| BOOKER & ASSOCIATES, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| TIMKO, JOHN R, DC | Manager | 844 N. STONE STREET, SUITE 202, DELAND, FL 32720 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000102537 | COMPLETE WELLNESS MEDICAL CENTER | ACTIVE | 2024-08-28 | 2029-12-31 | No data | 844 N. STONE STREET, SUITE 202, DELAND, FL, 32720 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-08-21 |
Date of last update: 07 Feb 2025
Sources: Florida Department of State
