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THE BOLICK CLINIC, INC.

Company Details

Entity Name: THE BOLICK CLINIC, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 May 2000 (25 years ago)
Document Number: P00000047540
FEI/EIN Number 593644288
Address: 500 E. HORATIO AVE, STE 5, MAITLAND, FL, 32751
Mail Address: 500 E. HORATIO AVE, STE 5, MAITLAND, FL, 32751
ZIP code: 32751
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1073680088 2006-11-29 2019-06-04 500 E HORATIO AVE, SUITE 5, MAITLAND, FL, 327517310, US 500 E HORATIO AVE, SUITE 5, MAITLAND, FL, 327517310, US

Contacts

Phone +1 407-629-5333
Fax 4076295343

Authorized person

Name DR. CHANNING C. BOLICK
Role PRESIDENT
Phone 4076295333

Taxonomy

Taxonomy Code 111N00000X - Chiropractor
Is Primary No
Taxonomy Code 171100000X - Acupuncturist
Is Primary No
Taxonomy Code 261QM1300X - Multi-Specialty Clinic/Center
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 3819132-00
State FL
Issuer BLUE CROSS GROUP NUMBER
Number 55996
State FL

Agent

Name Role Address
BOLICK CHANNING C Agent 500 E. HORATIO AVE, MAITLAND, FL, 32751

Director

Name Role Address
BOLICK CHANNING C Director 500 E. HORATIO AVE, MAITLAND, FL, 32751

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000019102 MAITLAND CHIROPRACTIC CENTER ACTIVE 2023-02-09 2028-12-31 No data 500 E HORATIO AVE, MAITLAND, FL, 32751
G23000019108 MAITLAND CHIROPRACTIC CENTRE ACTIVE 2023-02-09 2028-12-31 No data BOLICK CLINIC, 500 E HORATIO AVE, MAITLAND, FL, 32751
G17000132744 MAITLAND CHIROPRACTIC CLINIC ACTIVE 2017-12-05 2027-12-31 No data 500 E HORATIO AVE STE 5, MAITLAND, FL, 32751--731
G17000126891 MAITLAND CHIROPRACTIC ACTIVE 2017-11-17 2027-12-31 No data 500 E. HORATIO AVE STE 5, MAITLAND, FL, 32751

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2005-01-07 500 E. HORATIO AVE, STE 5, MAITLAND, FL 32751 No data
CHANGE OF MAILING ADDRESS 2005-01-07 500 E. HORATIO AVE, STE 5, MAITLAND, FL 32751 No data

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-03-03
ANNUAL REPORT 2022-04-29
ANNUAL REPORT 2021-03-19
ANNUAL REPORT 2020-04-30
ANNUAL REPORT 2019-04-17
ANNUAL REPORT 2018-03-22
ANNUAL REPORT 2017-03-21
ANNUAL REPORT 2016-04-19
ANNUAL REPORT 2015-01-26

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
3285527102 2020-04-11 0491 PPP 500 E HORATIO AVE STE 5, MAITLAND, FL, 32751-4521
Loan Status Date 2021-07-17
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 15069
Loan Approval Amount (current) 15069
Undisbursed Amount 0
Franchise Name -
Lender Location ID 67422
Servicing Lender Name First Horizon Bank
Servicing Lender Address 165 Madison Ave, MEMPHIS, TN, 38103-2723
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address MAITLAND, ORANGE, FL, 32751-4521
Project Congressional District FL-10
Number of Employees 4
NAICS code 621310
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 78586
Originating Lender Name IberiaBank, A Division of First Horizon Bank
Originating Lender Address Lafayette, LA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 15239.36
Forgiveness Paid Date 2021-06-09
5671908407 2021-02-09 0491 PPS 500 E Horatio Ave Ste 5, Maitland, FL, 32751-7310
Loan Status Date 2021-10-21
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 16850
Loan Approval Amount (current) 16850
Undisbursed Amount 0
Franchise Name -
Lender Location ID 67422
Servicing Lender Name First Horizon Bank
Servicing Lender Address 165 Madison Ave, MEMPHIS, TN, 38103-2723
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Maitland, ORANGE, FL, 32751-7310
Project Congressional District FL-10
Number of Employees 4
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 67422
Originating Lender Name First Horizon Bank
Originating Lender Address MEMPHIS, TN
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 16949.23
Forgiveness Paid Date 2021-09-28

Date of last update: 01 Feb 2025

Sources: Florida Department of State