| Entity Name: | ACTIVE SPINE CENTER OF HOMESTEAD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Jun 2004 (21 years ago) |
| Document Number: | P04000098795 |
| FEI/EIN Number | 201313310 |
| Address: | 33550 SOUTH DIXIE HWY, FLORIDA CITY, FL, 33034, US |
| Mail Address: | 33550 SOUTH DIXIE HWY, FLORIDA CITY, FL, 33034, US |
| ZIP code: | 33034 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902826845 | 2006-07-21 | 2012-01-27 | 33550 S DIXIE HWY, SUITE 132, FLORIDA CITY, FL, 330345602, US | 33550 S DIXIE HWY, SUITE 132, FLORIDA CITY, FL, 330345602, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 305-242-6665 |
| Fax | 3052426919 |
Authorized person
| Name | DR. JASON SCOTT LOPATE |
| Role | CHIROPRACTOR |
| Phone | 3052426665 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH8338 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 382025400 |
| State | FL |
| Issuer | MEDICAID |
| Number | 382091200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOPATE JASON S | Agent | 33550 SOUTH DIXIE HWY, FLORIDA CITY, FL, 33034 |
| Name | Role | Address |
|---|---|---|
| LOPATE JASON S | President | 33550 SOUTH DIXIE HWY #132, FLORIDA CITY, FL, 33034 |
| Name | Role | Address |
|---|---|---|
| LOPATE JASON S | Director | 33550 SOUTH DIXIE HWY #132, FLORIDA CITY, FL, 33034 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000017386 | ACTIVE SPINE CENTER | ACTIVE | 2011-02-15 | 2026-12-31 | No data | 33550 SOUTH DIXIE HWY, SUITE 132, FLORIDA CITY, FL, 33034 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2013-03-28 | 33550 SOUTH DIXIE HWY, Suite 132, FLORIDA CITY, FL 33034 | No data |
| CHANGE OF MAILING ADDRESS | 2013-03-28 | 33550 SOUTH DIXIE HWY, Suite 132, FLORIDA CITY, FL 33034 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-03-28 | 33550 SOUTH DIXIE HWY, Suite 132, FLORIDA CITY, FL 33034 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-17 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-18 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-03-20 |
| ANNUAL REPORT | 2016-01-15 |
| ANNUAL REPORT | 2015-02-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
