| Entity Name: | ROD DAVIS CHIROPRACTIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 05 Aug 2002 (22 years ago) |
| Document Number: | P02000084494 |
| FEI/EIN Number | 41-2054892 |
| Address: | 155 EAST INTERLAKE BOULEVARD, LAKE PLACID, FL 33852 |
| Mail Address: | 155 EAST INTERLAKE BOULEVARD, LAKE PLACID, FL 33852 |
| ZIP code: | 33852 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477721918 | 2008-02-19 | 2008-11-25 | 155 E INTERLAKE BLVD, LAKE PLACID, FL, 338529578, US | 155 E INTERLAKE BLVD, LAKE PLACID, FL, 338529578, US | |||||||||||||||||||||||||
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| Phone | +1 863-699-0111 |
| Fax | 8636991046 |
Authorized person
| Name | ROGER F DAVIS |
| Role | OWNER |
| Phone | 8636990111 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0007552 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 280013600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DAVIS, JR, ROGER FD.C. | Agent | 155 EAST INTERLAKE BOULEVARD, LAKE PLACID, FL 33852 |
| Name | Role | Address |
|---|---|---|
| DAVIS, JR, ROGER FD.C. | President | 155 EAST INTERLAKE BOULEVARD, LAKE PLACID, FL 33852 |
| Name | Role | Address |
|---|---|---|
| DAVIS, JR, ROGER FD.C. | Director | 155 EAST INTERLAKE BOULEVARD, LAKE PLACID, FL 33852 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-05-01 | 155 EAST INTERLAKE BOULEVARD, LAKE PLACID, FL 33852 | No data |
| CHANGE OF MAILING ADDRESS | 2009-05-01 | 155 EAST INTERLAKE BOULEVARD, LAKE PLACID, FL 33852 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-05-01 | 155 EAST INTERLAKE BOULEVARD, LAKE PLACID, FL 33852 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-01-24 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-02-22 |
| ANNUAL REPORT | 2016-04-02 |
| ANNUAL REPORT | 2015-05-04 |
Date of last update: 30 Jan 2025
Sources: Florida Department of State
