| Entity Name: | BASSETT FAMILY CHIROPRACTIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Mar 1999 (26 years ago) |
| Document Number: | P99000028169 |
| FEI/EIN Number | 593564335 |
| Address: | 201 FLORIDA PLACE, FORT WALTON BEACH, FL, 32548, US |
| Mail Address: | 201 FLORIDA PLACE, FORT WALTON BEACH, FL, 32548, US |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902841851 | 2006-06-17 | 2020-08-22 | 201 FLORIDA PL SE, FORT WALTON BEACH, FL, 325485812, US | 201 FLORIDA PL SE, FORT WALTON BEACH, FL, 325485812, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 850-301-0900 |
| Fax | 8503010606 |
Authorized person
| Name | DR. TIMOTHY M BASSETT |
| Role | PRESIDENT |
| Phone | 8503010900 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH0007652 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 55835 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BASSETT TIMOTHY M | Agent | 201 FLORIDA PLACE, FORT WALTON BEACH, FL, 32548 |
| Name | Role | Address |
|---|---|---|
| BASSETT TIMOTHY M | Director | 201 FLORIDA PLACE, FORT WALTON BEACH, FL, 32548 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000088599 | CORNERSTONE CHIROPRACTIC | ACTIVE | 2020-07-27 | 2025-12-31 | No data | 201 FLORIDA PLACE, FORT WALTON BEACH, FL, 32548 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2009-01-08 | 201 FLORIDA PLACE, FORT WALTON BEACH, FL 32548 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-01-08 | 201 FLORIDA PLACE, FORT WALTON BEACH, FL 32548 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-03-23 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-03-23 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-02-14 |
| ANNUAL REPORT | 2017-04-19 |
| ANNUAL REPORT | 2016-03-09 |
| ANNUAL REPORT | 2015-03-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
