| Entity Name: | CHIROPRACTIC ASSOCIATES OF SOUTHWEST FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 14 Sep 2011 (13 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P11000080998 |
| FEI/EIN Number | 45-3275197 |
| Address: | 9371 CYPRESS LAKE DRIVE, SUITE 8, FORT MYERS, FL 33919 |
| Mail Address: | P. O. BOX 07267, FORT MYERS, FL 33919 |
| ZIP code: | 33919 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356509582 | 2008-05-23 | 2012-10-08 | 8801 COLLEGE PKWY, SUITE 2, FORT MYERS, FL, 339194882, US | 8801 COLLEGE PKWY, SUITE 2, FORT MYERS, FL, 339194882, US | |||||||||||||||||||||||||
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| Phone | +1 239-437-2885 |
| Fax | 2394824757 |
Authorized person
| Name | DR. ESMAEEL SAMALIAZAD |
| Role | PHYSICIAN |
| Phone | 2394372885 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | CH8642 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 381698200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SAMALIAZAD, ESMAEEL, DC | Agent | 8801 COLLEGE PARKWAY, 2, FORT MYERS, FL 33919 |
| Name | Role | Address |
|---|---|---|
| SAMALIAZAD, ESMAEEL, DC | President | 8801 COLLEGE PARKWAY, SUITE #2, FORT MYERS, FL 33919 |
| Name | Role | Address |
|---|---|---|
| SAMALIAZAD, ESMAEEL, DC | Director | 8801 COLLEGE PARKWAY, SUITE #2, FORT MYERS, FL 33919 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-03-28 | 9371 CYPRESS LAKE DRIVE, SUITE 8, FORT MYERS, FL 33919 | No data |
| CHANGE OF MAILING ADDRESS | 2013-03-28 | 9371 CYPRESS LAKE DRIVE, SUITE 8, FORT MYERS, FL 33919 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-02-08 |
| ANNUAL REPORT | 2012-02-28 |
| Domestic Profit | 2011-09-14 |
Date of last update: 23 Feb 2025
Sources: Florida Department of State
