| Entity Name: | DR. REZA GHASSEMI, D.C., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Dec 2006 (18 years ago) |
| Document Number: | P06000155712 |
| FEI/EIN Number | 510614387 |
| Address: | 4800 4th St. N, ST. PETERSBURG, FL, 33703, US |
| Mail Address: | 4800 4th St. N, ST. PETERSBURG, FL, 33703, US |
| ZIP code: | 33703 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881016798 | 2014-01-11 | 2014-01-11 | 5625 4TH ST N, SUITE 2B, ST PETERSBURG, FL, 337032260, US | 5625 4TH ST N, SUITE 2B, ST PETERSBURG, FL, 337032260, US | |||||||||||||||||||||||
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| Phone | +1 727-519-7443 |
Authorized person
| Name | DR. REZA GHASSEMI |
| Role | PRESIDENT |
| Phone | 7275197443 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH9274 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002090200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GHASSEMI REZA | Agent | 4900 Central Ave, St. Petersburg, FL, 33707 |
| Name | Role | Address |
|---|---|---|
| GHASSEMI REZA | President | 421 W. Story St., Bozeman, MT, 59715 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-08 | 4800 4th St. N, ST. PETERSBURG, FL 33703 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-08 | 4800 4th St. N, ST. PETERSBURG, FL 33703 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-08 | 4900 Central Ave, St. Petersburg, FL 33707 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-03-11 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
