| Name: | Full Life Regeneration, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 19 May 2021 (3 years ago) |
| Entity Number: | 000-860-044 |
| Register Number: | 000860044 |
| County: | Lauderdale |
| Place of Formation: | Alabama |
| Principal Address: | 117 Renaissance StreetFlorence, AL 35630 |
| Principal Address ZIP Code: | 35630 |
| Authorized Capital: | 1000 |
| Paid Share Capital: | 1.00 |
Activities
See attached.
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609464395 | 2021-01-07 | 2021-05-26 | 117 RENAISSANCE ST, FLORENCE, AL, 356301207, US | 117 RENAISSANCE ST, FLORENCE, AL, 356301207, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-765-0002 |
| Fax | 2567650022 |
Authorized person
| Name | TYLER MELSON |
| Role | OWNER |
| Phone | 2567650002 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | 1769 |
| State | AL |
| Name | Role |
|---|---|
| Melson, Matthew T D.O. | Agent |
| Name | Role | Address |
|---|---|---|
| MELSON, MATTHEW T D.O. | Incorporator | 117 RENAISSANCE STREETFLORENCE, AL 35630-8062 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
