| Entity Name: | SOUTH BROWARD PAIN & REHAB CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 08 Jun 1998 (27 years ago) |
| Document Number: | P98000052003 |
| FEI/EIN Number | 650915185 |
| Address: | 6049 MIRAMAR PARKWAY, MIRAMAR, FL, 33023 |
| Mail Address: | 6049 MIRAMAR PARKWAY, MIRAMAR, FL, 33023 |
| ZIP code: | 33023 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437226776 | 2006-11-30 | 2020-08-22 | 6049 MIRAMAR PKWY, MIRAMAR, FL, 330239337, US | 6049 MIRAMAR PKWY, MIRAMAR, FL, 330233937, US | |||||||||||||||||||||||||
|
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| Phone | +1 954-983-4410 |
| Fax | 9549838354 |
Authorized person
| Name | MR. ERIC R. MILLER |
| Role | CLINICAL DIRECTOR |
| Phone | 9549834410 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH5357 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUECROSS ID# |
| Number | 22167 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MILLER ERIC | Agent | 6049 MIRAMAR PARKWAY, MIRAMAR, FL, 33023 |
| Name | Role | Address |
|---|---|---|
| MILLER ERIC | Director | 6049 MIRAMAR PARKWAY, MIRAMAR, FL, 33023 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REINSTATEMENT | 2012-11-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13000851783 | TERMINATED | 1000000444986 | BROWARD | 2013-04-29 | 2023-05-03 | $ 634.86 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| J10000782661 | TERMINATED | 1000000181730 | BROWARD | 2010-07-19 | 2020-07-21 | $ 2,524.45 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3111 N UNIVERSITY DR STE 501, CORAL SPRINGS FL330655096 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
