| Entity Name: | BROOKS CHIROPRACTIC CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Dec 2004 (20 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P04000169211 |
| FEI/EIN Number | 841665680 |
| Address: | 5261 HWY 90, PACE, FL, 32571 |
| Mail Address: | 5261 HWY 90, PACE, FL, 32571 |
| ZIP code: | 32571 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477734242 | 2007-11-20 | 2007-11-27 | 5261 HIGHWAY 90, PACE, FL, 325711532, US | 5261 HIGHWAY 90, PACE, FL, 325711532, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 850-994-1147 |
| Fax | 8509941104 |
Authorized person
| Name | DR. MICHAEL C. BROOKS |
| Role | CHIROPRACTIC PHYSICIAN |
| Phone | 8509941147 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0003384 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 88558 |
| State | FL |
| Issuer | AETNA |
| Number | 4276754 |
| State | FL |
| Issuer | MEDICARE INDIVIDUAL |
| Number | 88558Z |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BROOKS MICHAEL C | Agent | 5261 HWY 90, PACE, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| BROOKS MICHAEL C | Director | 5261 HWY 90, PACE, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| BROOKS MICHAEL C | President | 5261 HWY 90, PACE, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| LAWRENCE TERESA | Secretary | 4848 FRIENDLY ST, PACE, FL, 32571 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| AMENDMENT | 2010-11-08 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-03-03 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-03-26 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-22 |
| ANNUAL REPORT | 2015-02-10 |
| ANNUAL REPORT | 2014-04-14 |
| ANNUAL REPORT | 2013-04-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
