| Entity Name: | ALAFAYA CHIROPRACTIC CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 Jun 2002 (23 years ago) |
| Date of dissolution: | 24 Sep 2010 (14 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2010 (14 years ago) |
| Document Number: | P02000063568 |
| FEI/EIN Number | 010722544 |
| Address: | 11905 E. COLONIAL DRIVE, ORLANDO, FL, 32826 |
| Mail Address: | 11905 E. COLONIAL DRIVE, ORLANDO, FL, 32826 |
| ZIP code: | 32826 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366710147 | 2011-12-07 | 2011-12-07 | 11905 E COLONIAL DR, ORLANDO, FL, 328264725, US | 11905 E COLONIAL DR, ORLANDO, FL, 328264725, US | |||||||||||||||||||||||||||||||
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| Phone | +1 407-281-0900 |
| Fax | 4072810900 |
Authorized person
| Name | DR. DAVID ALLEN INDERWIESEN |
| Role | PRESIDENT |
| Phone | 4072810900 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH 5802 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 381458100 |
| State | FL |
| Issuer | BLUE CROSS AND BLUE SHIELD OF FLORIDA |
| Number | 22661 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| INDERWIESEN DAVID | Agent | 11905 E. COLONIAL DRIVE, ORLANDO, FL, 32826 |
| Name | Role | Address |
|---|---|---|
| INDERWIESEN DAVID | President | 11905 E. COLONIAL DRIVE, ORLANDO, FL, 32826 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-02-07 | 11905 E. COLONIAL DRIVE, ORLANDO, FL 32826 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-06-05 | 11905 E. COLONIAL DRIVE, ORLANDO, FL 32826 | No data |
| CHANGE OF MAILING ADDRESS | 2003-06-05 | 11905 E. COLONIAL DRIVE, ORLANDO, FL 32826 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2009-01-06 |
| ANNUAL REPORT | 2008-02-28 |
| ANNUAL REPORT | 2007-01-25 |
| ANNUAL REPORT | 2006-07-11 |
| ANNUAL REPORT | 2005-02-07 |
| ANNUAL REPORT | 2004-01-31 |
| ANNUAL REPORT | 2003-06-05 |
| Domestic Profit | 2002-06-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
