| Entity Name: | BRANDON MEDICAL WELLNESS CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Sep 1996 (28 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P96000077656 |
| FEI/EIN Number | 593391679 |
| Address: | 807 SOUTH PARSONS AVENUE, BRANDON, FL, 33511 |
| Mail Address: | 807 SOUTH PARSONS AVENUE, BRANDON, FL, 33511 |
| ZIP code: | 33511 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881697035 | 2005-05-23 | 2011-01-11 | 807 S PARSONS AVE, BRANDON, FL, 335116063, US | 807 S PARSONS AVE, BRANDON, FL, 335116063, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 813-684-8141 |
| Fax | 8136891140 |
Authorized person
| Name | JOHN S MORGAN |
| Role | OWNER |
| Phone | 8136848141 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0005360 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0005666 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH9344 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME46540 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| License Number | OT9814 |
| State | FL |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRANDON MEDICAL WELLNESS CENTER 401K PROFIT SHARING PLAN | 2010 | 593391679 | 2011-10-17 | BRANDON MEDICAL WELLNESS CENTER | 20 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 593391679 |
| Plan administrator’s name | BRANDON MEDICAL WELLNESS CENTER |
| Plan administrator’s address | 807 S PARSONS AVE, BRANDON, FL, 33511 |
| Administrator’s telephone number | 8136848141 |
Signature of
| Role | Plan administrator |
| Date | 2011-10-17 |
| Name of individual signing | JOHN S. MORGAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2005-01-01 |
| Business code | 621310 |
| Sponsor’s telephone number | 8136848141 |
| Plan sponsor’s address | 807 S PARSONS AVE, BRANDON, FL, 33511 |
Plan administrator’s name and address
| Administrator’s EIN | 593391679 |
| Plan administrator’s name | BRANDON MEDICAL WELLNESS CENTER |
| Plan administrator’s address | 807 S PARSONS AVE, BRANDON, FL, 33511 |
| Administrator’s telephone number | 8136848141 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-16 |
| Name of individual signing | JOHN S. MORGAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| WETHERINGTON KENNETH A | Agent | 807 S Parsons Ave, Brandon, FL, 33511 |
| Name | Role | Address |
|---|---|---|
| Wetherington Kenneth ADr. | Director | 807 SOUTH PARSONS AVENUE, BRANDON, FL, 33511 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000066944 | NECK AND BACK CENTER | EXPIRED | 2011-07-06 | 2016-12-31 | No data | 807 S. PARSONS AVE., BRANDON, FL, 33511 |
| G10000089563 | PHYSICAL MEDICINE & REHABILITATION | EXPIRED | 2010-09-30 | 2015-12-31 | No data | 807 S. PARSONS AVENUE, BRANDON, FL, 33511 |
| G10000089564 | PHYSICAL MEDICINE & REHABILITATION OF BRANDON | EXPIRED | 2010-09-30 | 2015-12-31 | No data | 807 S. PARSONS AVENUE, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-08-07 | WETHERINGTON, KENNETH A | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-08-07 | 807 S Parsons Ave, Brandon, FL 33511 | No data |
| REINSTATEMENT | 2017-08-07 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-07-10 | 807 SOUTH PARSONS AVENUE, BRANDON, FL 33511 | No data |
| CHANGE OF MAILING ADDRESS | 2006-07-10 | 807 SOUTH PARSONS AVENUE, BRANDON, FL 33511 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2017-08-07 |
| ANNUAL REPORT | 2012-02-13 |
| ANNUAL REPORT | 2011-04-20 |
| ANNUAL REPORT | 2010-02-23 |
| ANNUAL REPORT | 2009-01-21 |
| ANNUAL REPORT | 2008-01-14 |
| ANNUAL REPORT | 2007-01-04 |
| ANNUAL REPORT | 2006-07-10 |
| ANNUAL REPORT | 2005-01-26 |
| ANNUAL REPORT | 2004-01-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
