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  5. EMERALD COAST CHIROPRACTIC, INC.

EMERALD COAST CHIROPRACTIC, INC.

Company Details

Entity Name: EMERALD COAST CHIROPRACTIC, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Inactive
Date Filed: 21 Oct 1998 (26 years ago)
Date of dissolution: 25 Sep 2015 (9 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 25 Sep 2015 (9 years ago)
Document Number: P98000090201
FEI/EIN Number 59-3540626
Address: 705 W JOHN SIMS PARKWAY STE A, NICEVILLE, FL 32578
Mail Address: 705 W JOHN SIMS PARKWAY STE A, NICEVILLE, FL 32578
ZIP code: 32578
County: Okaloosa
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1871519165 2006-07-14 2013-02-05 705 JOHN SIMS PKWY W, NICEVILLE, FL, 325781878, US 705 JOHN SIMS PKWY W, NICEVILLE, FL, 325781878, US

Contacts
Phone +1 850-678-8048
Fax 8506782629

Authorized person
Name DR. DEAN CALLAHAN JACKS
Role PRESIDENT
Phone 8506788048

Taxonomy
Taxonomy Code 111N00000X - Chiropractor
License Number CH0007070
State FL
Is Primary Yes

Other Provider Identifiers
Issuer BLUE CROSS BLUE SHIELD
Number 55426
State FL
Issuer RAILRAOD MEDICARE
Number DA1478
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2019 593540626 2020-03-10 EMERALD COAST CHIROPRACTIC, INC. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 25 OLD FERRY RD, SHALIMAR, FL, 32579
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2018 593540626 2019-02-18 EMERALD COAST CHIROPRACTIC, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 25 OLD FERRY RD, SHALIMAR, FL, 32579
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2017 593540626 2018-10-10 EMERALD COAST CHIROPRACTIC, INC. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 25 OLD FERRY RD, SHALIMAR, FL, 32579
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2017 593540626 2018-10-03 EMERALD COAST CHIROPRACTIC, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 25 OLD FERRY RD, SHALIMAR, FL, 32579
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2016 593540626 2017-10-16 EMERALD COAST CHIROPRACTIC, INC. 8
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 705 JOHN SIMS PARKWAY WEST, SUITE A, NICEVILLE, FL, 32578
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2016 593540626 2018-10-03 EMERALD COAST CHIROPRACTIC, INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 25 OLD FERRY RD, SHALIMAR, FL, 32579
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2015 593540626 2018-10-03 EMERALD COAST CHIROPRACTIC, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 25 OLD FERRY RD, SHALIMAR, FL, 32579
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2015 593540626 2016-10-17 EMERALD COAST CHIROPRACTIC, INC. 8
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 705 JOHN SIMS PARKWAY WEST, SUITE A, NICEVILLE, FL, 32578
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2014 593540626 2018-10-03 EMERALD COAST CHIROPRACTIC, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 25 OLD FERRY RD, SHALIMAR, FL, 32579
EMERALD COAST CHIROPRACTIC, INC. 401(K) PROFIT SHARING PLAN 2014 593540626 2015-10-15 EMERALD COAST CHIROPRACTIC, INC. 8
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621310
Sponsor’s telephone number 8506788048
Plan sponsor’s address 705 JOHN SIMS PARKWAY WEST, SUITE A, NICEVILLE, FL, 32578

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing SCOTT EWING
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
EWING, SCOTT E Agent 705 W JOHN SIMS PARKWAY STE A, NICEVILLE, FL 32578

President

Name Role Address
JACKS, DEAN C President 705 W JOHN SIMS PKWY, NICEVILLE, FL 32578

Vice President

Name Role Address
EWING, SCOTT E Vice President 705 W. JOHN SIMS PKWY, NICEVILLE, FL 32578

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2015-09-25 No data No data

Documents

Name Date
ANNUAL REPORT 2014-02-11
ANNUAL REPORT 2013-04-09
ANNUAL REPORT 2012-01-12
ANNUAL REPORT 2011-03-23
ANNUAL REPORT 2010-03-02
ANNUAL REPORT 2009-04-02
ANNUAL REPORT 2008-01-04
ANNUAL REPORT 2007-01-29
ANNUAL REPORT 2006-01-26
ANNUAL REPORT 2005-02-12

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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