| Entity Name: | NORTHWEST CENTER FOR INTEGRATIVE MEDICINE & REHABILITATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 18 Feb 2003 (22 years ago) |
| Date of dissolution: | 25 Jan 2011 (14 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 25 Jan 2011 (14 years ago) |
| Document Number: | P03000019606 |
| FEI/EIN Number | 38-3673389 |
| Address: | 2960 NORTH STATE ROAD 7, SUITE 204, MARGATE, FL 33063 |
| Mail Address: | 2960 NORTH STATE ROAD 7, SUITE 204, MARGATE, FL 33063 |
| ZIP code: | 33063 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477675999 | 2007-04-04 | 2008-08-11 | 2960 N STATE ROAD 7, SUITE 204, MARGATE, FL, 330635755, US | 2960 N STATE ROAD 7, SUITE 204, MARGATE, FL, 330635755, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-977-9077 |
| Fax | 9549790675 |
Authorized person
| Name | DR. ABRAHAM ROBERT FREEMAN |
| Role | DIRECTOR OF CLINIC |
| Phone | 9549779077 |
Taxonomy
| Taxonomy Code | 111NN1001X - Nutrition Chiropractor |
| License Number | CH0004917 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111NN1001X - Nutrition Chiropractor |
| License Number | CH0006667 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 171100000X - Acupuncturist |
| License Number | AP1704 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 171100000X - Acupuncturist |
| License Number | AP1605 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 204C00000X - Sports Medicine (Neuromusculoskeletal Medicine) Physician |
| License Number | ME27172 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 3811301-00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FREEMAN, ABRAHAM R | Agent | 2960 NORTH STATE ROAD 7, SUITE 204, MARGATE, FL 33063 |
| Name | Role | Address |
|---|---|---|
| FREEMAN, ABRAHAM R | Director | 11001 NW 12 DRIVE, CORAL SPRINGS, FL 33071 |
| WHITTEN, KIRK | Director | 810 NW 6 TERRACE, BOCA RATON, FL 33486 |
| Name | Role | Address |
|---|---|---|
| WHITTEN, KIRK | Vice President | 810 NW 6 TERRACE, BOCA RATON, FL 33486 |
| Name | Role | Address |
|---|---|---|
| WHITTEN, KIRK | Secretary | 810 NW 6 TERRACE, BOCA RATON, FL 33486 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2011-01-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2010-09-21 | FREEMAN, ABRAHAM R | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-04-16 | 2960 NORTH STATE ROAD 7, SUITE 204, MARGATE, FL 33063 | No data |
| CHANGE OF MAILING ADDRESS | 2004-04-16 | 2960 NORTH STATE ROAD 7, SUITE 204, MARGATE, FL 33063 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-04-16 | 2960 NORTH STATE ROAD 7, SUITE 204, MARGATE, FL 33063 | No data |
| NAME CHANGE AMENDMENT | 2003-10-07 | NORTHWEST CENTER FOR INTEGRATIVE MEDICINE & REHABILITATION, INC. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000683826 | TERMINATED | 10-47251 CA 18 | BROWARD COUNTY | 2011-09-28 | 2016-10-18 | $403,838.54 | MONTECITO MEDICAL - NW MEDICAL PARK, LLC, 200 E. RANDOLPH, CHICAGO, IL 60601 |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2011-01-25 |
| ANNUAL REPORT | 2010-09-21 |
| ANNUAL REPORT | 2009-01-15 |
| ANNUAL REPORT | 2008-04-09 |
| ANNUAL REPORT | 2007-07-05 |
| ANNUAL REPORT | 2006-04-17 |
| ANNUAL REPORT | 2005-03-14 |
| ANNUAL REPORT | 2004-04-16 |
| Name Change | 2003-10-07 |
| Domestic Profit | 2003-02-19 |
Date of last update: 06 Jan 2025
Sources: Florida Department of State
