| Entity Name: | CHIROPRACTIC HEALTH CLINIC OF BREVARD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Jan 2004 (21 years ago) |
| Document Number: | P04000008569 |
| FEI/EIN Number | 200571558 |
| Address: | 110 N TROPICAL TRAIL, MERRITT ISLAND, FL, 32953, US |
| Mail Address: | 110 N TROPICAL TRAIL, MERRITT ISLAND, FL, 32953, US |
| ZIP code: | 32953 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992995757 | 2007-07-27 | 2007-07-27 | 110 N TROPICAL TRL, MERRITT ISLAND, FL, 329534737, US | 110 N TROPICAL TRL, MERRITT ISLAND, FL, 329534737, US | |||||||||||||||||||||||
|
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| Phone | +1 321-459-9400 |
Authorized person
| Name | DR. PAUL VINCENT GRIMM |
| Role | PRESIDENT |
| Phone | 3214599400 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH 8328 FL |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE GROUP NUMBER |
| Number | K5848 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GRIMM PAUL V | Agent | 4086 SAN BELUGA WAY, ROCKLEDGE, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| GRIMM PAUL V | President | 4086 SAN BELUGA WAY, ROCKLEDGE, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| GRIMM KAREN | Vice President | 4086 SAN BELUGA WAY, ROCKLEDGE, FL, 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2009-03-12 | 110 N TROPICAL TRAIL, MERRITT ISLAND, FL 32953 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-03-12 | 4086 SAN BELUGA WAY, ROCKLEDGE, FL 32955 | No data |
| REGISTERED AGENT NAME CHANGED | 2008-04-28 | GRIMM, PAUL V | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-02-10 |
| ANNUAL REPORT | 2022-02-27 |
| ANNUAL REPORT | 2021-01-30 |
| ANNUAL REPORT | 2020-02-13 |
| ANNUAL REPORT | 2019-03-31 |
| ANNUAL REPORT | 2018-03-31 |
| ANNUAL REPORT | 2017-03-02 |
| ANNUAL REPORT | 2016-03-30 |
| ANNUAL REPORT | 2015-03-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
