| Entity Name: | STOUT FAMILY CHIROPRACTIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Jul 2012 (13 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 04 Apr 2013 (12 years ago) |
| Document Number: | P12000065028 |
| FEI/EIN Number | 46-0698523 |
| Address: | 6610 EAST FOWLER AVENUE,, SUITE D, Temple Terrace, FL, 33617, US |
| Mail Address: | 6610 EAST FOWLER AVENUE,, SUITE D, Temple Terrace, FL, 33617, US |
| ZIP code: | 33617 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073855086 | 2013-03-18 | 2016-12-08 | PO BOX 290285, TAMPA, FL, 336870285, US | 10956 N 56TH ST, 201, TEMPLE TERRACE, FL, 336173008, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-701-7272 |
| Fax | 8135011081 |
Authorized person
| Name | DR. ADAM STOUT |
| Role | PRESIDENT |
| Phone | 8137876764 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH10219 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH9983 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015449400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SANTAMARIA PAVLOA | Agent | 6610 E Fowler Ave, Temple Terrace, FL, 33617 |
| Name | Role | Address |
|---|---|---|
| SANTAMARIA PAVLOA | President | 6610 E Fowler Ave, Temple Terrace, FL, 33617 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000059061 | STOUT FAMILY CHIROPRACTIC HOLISTIC CENTER OF TAMPA | EXPIRED | 2019-05-17 | 2024-12-31 | No data | 10956 N 56TH STREET, SUITE 201, TEMPLE TERRACE, FL, 33617 |
| G13000113643 | CHIRO MAMA | EXPIRED | 2013-11-19 | 2018-12-31 | No data | 32031 TEAGUE WAY, WESLEY CHAPEL, FL, 33545 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-01-03 | SANTAMARIA, PAVLOA | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-03 | 6610 E Fowler Ave, Suite D, Temple Terrace, FL 33617 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-06-26 | 6610 EAST FOWLER AVENUE,, SUITE D, Temple Terrace, FL 33617 | No data |
| CHANGE OF MAILING ADDRESS | 2019-06-26 | 6610 EAST FOWLER AVENUE,, SUITE D, Temple Terrace, FL 33617 | No data |
| AMENDMENT AND NAME CHANGE | 2013-04-04 | STOUT FAMILY CHIROPRACTIC, P.A. | No data |
| AMENDMENT AND NAME CHANGE | 2013-03-20 | STOUT FAMILY CHIROPRACTIC OF SEVEN OAKS, P.A. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-07 |
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-03 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-03-03 |
| ANNUAL REPORT | 2019-02-18 |
| ANNUAL REPORT | 2018-02-23 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-03-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
