| Entity Name: | MARTIN JACOBSON, D.C., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 21 Mar 1991 (34 years ago) |
| Document Number: | S39839 |
| FEI/EIN Number | 593058239 |
| Address: | 1051 PORT MALABAR BLVD NE, SUITE 2, PALM BAY, FL, 32905 |
| Mail Address: | 1051 PORT MALABAR BLVD NE, SUITE 2, PALM BAY, FL, 32905 |
| ZIP code: | 32905 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174899041 | 2012-03-26 | 2012-03-26 | 1051 PORT MALABAR BLVD. NE, SUITE 2, PALM BAY, FL, 32905, US | 1051 PORT MALABAR BLVD NE, SUITE 2, PALM BAY, FL, 329055153, US | |||||||||||||||||||||||
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| Phone | +1 321-725-7003 |
Authorized person
| Name | DR. MARTIN JACOBSON |
| Role | OWNER |
| Phone | 3217257003 |
Taxonomy
| Taxonomy Code | 111NX0800X - Orthopedic Chiropractor |
| License Number | CH0004008 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051196000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JACOBSON MARTIN | Agent | 1051 PORT MALABAR BLVD NE, PALM BAY, FL, 32905 |
| Name | Role | Address |
|---|---|---|
| JACOBSON MARTIN | Director | 1051 PORT MALABAR BLVD, PALM BAY, FL, 32905 |
| Name | Role | Address |
|---|---|---|
| JACOBSON MARTIN | President | 1051 PORT MALABAR BLVD, PALM BAY, FL, 32905 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REINSTATEMENT | 1996-10-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1996-08-23 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
