| Entity Name: | CONFORTI CHIROPRACTIC AND WELLNESS CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Feb 1999 (26 years ago) |
| Document Number: | P99000015936 |
| FEI/EIN Number | 593558831 |
| Mail Address: | 4040 TAMPA ROAD, OLDSMAR, FL, 34677 |
| Address: | 4040 TAMPA ROAD, OLDSMAR, FL, 34677, UN |
| ZIP code: | 34677 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316010143 | 2006-11-17 | 2013-01-24 | 4040 TAMPA RD, OLDSMAR, FL, 346773205, US | 4040 TAMPA RD, OLDSMAR, FL, 346773205, US | |||||||||||||||||||||||||
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| Phone | +1 813-818-7499 |
| Fax | 8138187239 |
Authorized person
| Name | GEORGE WAYNE BLAKE |
| Role | BILLING MANAGER |
| Phone | 8138187499 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH7630 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002847800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CONFORTI CARL G | Agent | 4040 TAMPA ROAD, OLDSMAR, FL, 34677 |
| Name | Role | Address |
|---|---|---|
| CONFORTI CARL G | President | 4040 TAMPA ROAD, OLDSMAR, FL, 34677 |
| Name | Role | Address |
|---|---|---|
| CONFORTI CARL G | Vice President | 4040 TAMPA ROAD, OLDSMAR, FL, 34677 |
| Name | Role | Address |
|---|---|---|
| CONFORTI CARL G | Secretary | 4040 TAMPA ROAD, OLDSMAR, FL, 34677 |
| Name | Role | Address |
|---|---|---|
| CONFORTI CARL G | Treasurer | 4040 TAMPA ROAD, OLDSMAR, FL, 34677 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000086201 | CHAMPION WELLNESS CENTERS | ACTIVE | 2016-08-14 | 2026-12-31 | No data | 4040 TAMPA RD., OLDSMAR, FL, 34677 |
| G14000131744 | EPIC CHIROPRACTIC & WELLNESS | EXPIRED | 2014-12-30 | 2019-12-31 | No data | 4040 TAMPA RD, OLDSMAR, FL, 34677 |
| G14000014965 | ABUNDANT HEALTH CENTERS OF FLORIDA | EXPIRED | 2014-02-11 | 2019-12-31 | No data | 4040 TAMPA RD, OLDSMAR, FL, 34677 |
| G13000064270 | SUNCOAST HEALTH ALLIANCE | EXPIRED | 2013-06-25 | 2018-12-31 | No data | 4040 TAMPA RD, OLDSMAR, FL, 34677 |
| G12000009527 | LASTING IMPRESSIONS WEIGHT LOSS | EXPIRED | 2012-01-27 | 2017-12-31 | No data | 4040 TAMPA RD, OLDSMAR, FL, 34677 |
| G08168900459 | CONFORTI'S NATURAL WELLNESS CENTERS | EXPIRED | 2008-06-16 | 2013-12-31 | No data | 4040 TAMPA RD., OLDSMAR, FL, 34677 |
| G06240900066 | CONFORTI DISC INSTITUTE | ACTIVE | 2006-08-24 | 2026-12-31 | No data | 4040 TAMPA RD, OLDSMAR, FL, 34677 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-08 | 4040 TAMPA ROAD, OLDSMAR, FL 34677 UN | No data |
| CHANGE OF MAILING ADDRESS | 2006-04-11 | 4040 TAMPA ROAD, OLDSMAR, FL 34677 UN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-04-11 | 4040 TAMPA ROAD, OLDSMAR, FL 34677 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-05-07 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-13 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
