| Entity Name: | LEESBURG CHIROPRACTIC CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Apr 1995 (30 years ago) |
| Document Number: | P95000030969 |
| FEI/EIN Number | 593307666 |
| Address: | 9421 S E MARICAMP ROAD, OCALA, FL, 34472, US |
| Mail Address: | 9421 S E MARICAMP ROAD, OCALA, FL, 34472, US |
| ZIP code: | 34472 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255680021 | 2012-09-07 | 2012-09-07 | 1107 W NORTH BLVD, #23, LEESBURG, FL, 34748, US | 1107 W NORTH BLVD, #23, LEESBURG, FL, 34748, US | |||||||||||||||||||||||||
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| Phone | +1 352-787-4500 |
| Fax | 3527878955 |
Authorized person
| Name | MR. ALAN D NEWMAN |
| Role | OWNER |
| Phone | 3527874500 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0005771 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051041600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NEWMAN ALAN D | Agent | 9421 S E MARICAMP ROAD, OCALA, FL, 34472 |
| Name | Role | Address |
|---|---|---|
| NEWMAN ALAN D | President | 9421 S E MARICAMP ROAD, OCALA, FL, 34472 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
