| Entity Name: | AMERICAN FAMILY & SPORTS CHIROPRACTIC CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Nov 2001 (23 years ago) |
| Document Number: | P01000110066 |
| FEI/EIN Number | 593756167 |
| Address: | 4649 CLYDE MORRIS BLVD, #609, PORT ORANGE, FL, 32129, US |
| Mail Address: | 4649 CLYDE MORRIS BLVD, #609, PORT ORANGE, FL, 32129, US |
| ZIP code: | 32129 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669645057 | 2008-04-08 | 2018-05-18 | 4649 CLYDE MORRIS BLVD UNIT 609, PORT ORANGE, FL, 321293003, US | 4649 CLYDE MORRIS BLVD UNIT 609, PORT ORANGE, FL, 32129, US | |||||||||||||||||||||||||
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| Phone | +1 386-760-6150 |
| Fax | 3867881998 |
Authorized person
| Name | DR. ELIZABETH JANE HENNIGHAN |
| Role | PRES |
| Phone | 3867606150 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH7773 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 382037800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HENNIGHAN ELIZABETH JD. C. | Agent | 4649 CLYDE MORRIS BLVD, PORT ORANGE, FL, 32129 |
| Name | Role | Address |
|---|---|---|
| HENNIGHAN ELIZABETH JDr. | President | 4649 CLYDE MORRIS BLVD, PORT ORANGE, FL, 32129 |
| Name | Role | Address |
|---|---|---|
| HENNIGHAN ELIZABETH JDr. | Treasurer | 4649 CLYDE MORRIS BLVD, PORT ORANGE, FL, 32129 |
| Name | Role | Address |
|---|---|---|
| HENNIGHAN ELIZABETH JDr. | Secretary | 4649 CLYDE MORRIS BLVD, PORT ORANGE, FL, 32129 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-12 | 4649 CLYDE MORRIS BLVD, #609, PORT ORANGE, FL 32129 | No data |
| CHANGE OF MAILING ADDRESS | 2017-04-12 | 4649 CLYDE MORRIS BLVD, #609, PORT ORANGE, FL 32129 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-04-12 | HENNIGHAN, ELIZABETH J, D. C. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-12 | 4649 CLYDE MORRIS BLVD, #609, PORT ORANGE, FL 32129 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-03-10 |
| ANNUAL REPORT | 2020-04-28 |
| ANNUAL REPORT | 2019-03-07 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-04-12 |
| ANNUAL REPORT | 2016-04-18 |
| ANNUAL REPORT | 2015-03-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
