| Entity Name: | SPACE COAST CORPORATE HEALTH SERVICE, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Jul 2000 (25 years ago) |
| Document Number: | P00000070385 |
| FEI/EIN Number | 593662070 |
| Address: | 145 PALM BAY RD NE, STE 120, WEST MELBOURNE, FL, 32904 |
| Mail Address: | 145 PALM BAY RD NE, STE 120, WEST MELBOURNE, FL, 32904 |
| ZIP code: | 32904 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356334718 | 2005-08-31 | 2024-08-23 | 145 PALM BAY RD NE, STE 120, MELBOURNE, FL, 329048601, US | 145 PALM BAY RD NE, STE 120, MELBOURNE, FL, 329048601, US | |||||||||||||||||||||||||
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| Phone | +1 321-725-8778 |
| Fax | 3219845299 |
Authorized person
| Name | BRADLEY JE CLOW |
| Role | PRESIDENT |
| Phone | 3217258778 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH4422 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 34121 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLOW BRADLEY J | Agent | 145 PALM BAY RD NE, WEST MELBOURNE, FL, 32904 |
| Name | Role | Address |
|---|---|---|
| CLOW BRADLEY | Director | 145 PALM BAY RD NE, PALM BAY, FL, 32904 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000135626 | CLOW COMPREHENSIVE HEALTH SOLUTIONS | EXPIRED | 2017-12-12 | 2022-12-31 | No data | 145 PALM BAY RD NE STE 120, W. MELBOURNE, FL, 32904 |
| G17000004136 | CLOW ULTIMATE HEALTH SOLUTIONS | EXPIRED | 2017-01-11 | 2022-12-31 | No data | 145 PALM BAY RD NE STE 120, WEST MELBOURNE, FL, 32904 |
| G12000013813 | CLOW CHIROPRACTIC OFFICE | ACTIVE | 2012-02-08 | 2027-12-31 | No data | 145 PALM BAY RD STE 120, UNIT 120, WEST MELBOURNE, FL, 32904 |
| G12000013820 | SCCHS | ACTIVE | 2012-02-08 | 2027-12-31 | No data | 145 PALM BAY RD STE 120, UNIT 120, WEST MELBOURNE, FL, 32904 |
| G11000004710 | SPACE COAST CORPORATE HEALTH SERVICE | EXPIRED | 2011-01-10 | 2016-12-31 | No data | 145 PALM BAY RD., SUITE 120, WEST MELBOURNE, FL, 32904 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2000-11-22 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
