| Entity Name: | SEMINOLE CHIROPRACTIC, INJURY & WELLNESS CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Apr 2001 (24 years ago) |
| Document Number: | P01000041460 |
| FEI/EIN Number | 593715094 |
| Address: | 10863 PARK BLVD.,, SUITE 2, SEMINOLE, FL, 33772 |
| Mail Address: | 10863 PARK BLVD.,, SUITE 2, SEMINOLE, FL, 33772 |
| ZIP code: | 33772 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851570220 | 2007-11-01 | 2018-06-21 | 10863 PARK BLVD, SUITE 2, SEMINOLE, FL, 337725423, US | 10863 PARK BLVD, SUITE 2, SEMINOLE, FL, 337725423, US | |||||||||||||||||||||||||
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| Phone | +1 727-399-2229 |
| Fax | 7273992228 |
Authorized person
| Name | DR. STEPHEN S NICKSE |
| Role | CHIROPRACTOR |
| Phone | 7273992229 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | HCC 2141 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 381927200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH ELAINE L | Agent | 10863 PARK BLVD., SEMINOLE, FL, 33772 |
| Name | Role | Address |
|---|---|---|
| NICKSE STEPHEN | President | 11248 106TH AVE, LARGO, FL, 33778 |
| Name | Role | Address |
|---|---|---|
| SMITH ELAINE | Secretary | 7131 122ND WAY N, SEMINOLE, FL, 33772 |
| Name | Role | Address |
|---|---|---|
| SMITH ELAINE | Treasurer | 7131 122ND WAY N, SEMINOLE, FL, 33772 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2013-10-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
