| Entity Name: | L. LEE SMITH D.C., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 06 Dec 1996 (28 years ago) |
| Date of dissolution: | 21 Jan 2024 (a year ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 21 Jan 2024 (a year ago) |
| Document Number: | P96000099011 |
| FEI/EIN Number | 65-0715888 |
| Mail Address: | 3450 S. Highway A1A, Melbourne Beach, FL 32951 |
| Address: | 220 N. Babcock St., MELBOURNE, FL 32935 |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336424506 | 2011-10-19 | 2020-09-09 | 220 N BABCOCK ST, MELBOURNE, FL, 329356717, US | 100 W NEW HAVEN AVE, MELBOURNE, FL, 329014303, US | |||||||||||||||||||||||||
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| Phone | +1 321-327-7014 |
| Fax | 3218211924 |
Authorized person
| Name | DR. LARRY LEE SMITH |
| Role | PHYSICIAN/OWNER |
| Phone | 3213277014 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH7178 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 381082800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH, L LEE | Agent | 3450 S. Highway A1A, Melbourne Beach, FL 32951 |
| Name | Role | Address |
|---|---|---|
| SMITH, L LEE, Tami Smith | Director | 3450 S. Highway A1A, Melbourne Beach, FL 32951 |
| Name | Role | Address |
|---|---|---|
| SMITH, L LEE, Tami Smith | President | 3450 S. Highway A1A, Melbourne Beach, FL 32951 |
| Name | Role | Address |
|---|---|---|
| SMITH, TAMI | Vice President | 3450 S. Highway A1A, Melbourne Beach, FL 32951 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000120513 | BOCA CHIROPRACTIC | EXPIRED | 2016-11-07 | 2021-12-31 | No data | 9250 GLADES RD., SUITE 111, BOCA RATON, FL, 33434 |
| G12000095183 | HEATLHSOURCE OF BOCA RATON | EXPIRED | 2012-09-28 | 2017-12-31 | No data | 9250 GLADES ROAD, SUITE 111, BOCA RATON, FL, 33434 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2024-01-21 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-25 | 3450 S. Highway A1A, Melbourne Beach, FL 32951 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-25 | 220 N. Babcock St., MELBOURNE, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2018-01-16 | 220 N. Babcock St., MELBOURNE, FL 32935 | No data |
| CANCEL ADM DISS/REV | 2007-10-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| CANCEL ADM DISS/REV | 2005-09-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2004-11-04 | SMITH, L LEE | No data |
| CANCEL ADM DISS/REV | 2004-11-04 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2024-01-21 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-01-25 |
| ANNUAL REPORT | 2020-01-11 |
| ANNUAL REPORT | 2019-01-10 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-06 |
| ANNUAL REPORT | 2015-01-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
