| Entity Name: | EDWARD V. POTTER, D.C., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 12 Nov 1993 (31 years ago) |
| Document Number: | P93000079992 |
| FEI/EIN Number | 650454829 |
| Address: | 3424 17TH ST., SARASOTA, FL, 34235, US |
| Mail Address: | 3424 17TH ST., SARASOTA, FL, 34235, US |
| ZIP code: | 34235 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629387626 | 2010-09-25 | 2010-09-25 | 3424 17TH ST, SARASOTA, FL, 342358906, US | 3424 17TH ST, SARASOTA, FL, 342358906, US | |||||||||||||||||||||||||
|
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| Phone | +1 941-955-7788 |
| Fax | 9413658611 |
Authorized person
| Name | EDWARD V. POTTER |
| Role | PRESIDENT |
| Phone | 9419557788 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | 4047 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0501352-00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| POTTER EDWARD V | Agent | 3424 17TH ST, SARASOTA, FL, 34235 |
| Name | Role | Address |
|---|---|---|
| POTTER EDWARD V | President | 3424 17TH ST, SARASOTA, FL, 34235 |
| Name | Role | Address |
|---|---|---|
| POTTER EDWARD V | Vice President | 3424 17TH ST, SARASOTA, FL, 34235 |
| Name | Role | Address |
|---|---|---|
| POTTER EDWARD V | Secretary | 3424 17TH ST, SARASOTA, FL, 34235 |
| Name | Role | Address |
|---|---|---|
| POTTER EDWARD V | Treasurer | 3424 17TH ST, SARASOTA, FL, 34235 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
