| Entity Name: | DR. BRADLEY H. YOUNG, D.C., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 May 2002 (23 years ago) |
| Document Number: | P02000055470 |
| FEI/EIN Number | 030454846 |
| Address: | 1270 N Eglin Pkwy, Suite C-11, Shalimar, FL, 32579, US |
| Mail Address: | 1270 N Eglin Pkwy, Suite C-11, Shalimar, FL, 32579, US |
| ZIP code: | 32579 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972761757 | 2008-05-28 | 2014-06-23 | 6 11TH AVENUE, SUITE H-3, SHALIMAR, FL, 32579, US | 6 11TH AVENUE, SUITE H-3, SHALIMAR, FL, 32579, US | |||||||||||||||||||||||||||||
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| Phone | +1 850-613-2044 |
| Fax | 8506136593 |
Authorized person
| Name | DR. BRADLEY H YOUNG |
| Role | PRESIDENT |
| Phone | 8506132044 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH8376 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 381515300 |
| State | FL |
| Issuer | INDIVIDUAL NPI |
| Number | 1366538035 |
| Name | Role | Address |
|---|---|---|
| young bradley HDC, PA | Agent | 1270 N Eglin Pkwy, Shalimar, FL, 32579 |
| Name | Role | Address |
|---|---|---|
| YOUNG BRADLEY HDC, PA | President | 1270 N Eglin Pkwy, Shalimar, FL, 32579 |
| Name | Role | Address |
|---|---|---|
| YOUNG BRADLEY HDC, PA | Secretary | 1270 N Eglin Pkwy, Shalimar, FL, 32579 |
| Name | Role | Address |
|---|---|---|
| YOUNG BRADLEY HDC, PA | Treasurer | 1270 N Eglin Pkwy, Shalimar, FL, 32579 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000080646 | COASTAL CHIROPRACTIC | ACTIVE | 2015-08-04 | 2025-12-31 | No data | 1270 N EGLIN PARKWAY, SUITE C11, SHALIMAR, FL, 32579 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-03 | 1270 N Eglin Pkwy, Suite C-11, Shalimar, FL 32579 | No data |
| CHANGE OF MAILING ADDRESS | 2020-02-03 | 1270 N Eglin Pkwy, Suite C-11, Shalimar, FL 32579 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-02-03 | 1270 N Eglin Pkwy, Suite C-11, Shalimar, FL 32579 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-21 | young, bradley HAMILTON, DC, PA | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-02-03 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-03-28 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-04-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
