| Name: | Advanced Integrative Medicine, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 27 Nov 2023 (a year ago) |
| Date of Dissolution: | 04 Mar 2024 (a year ago) |
| Date of Status Change: | 04 Mar 2024 (a year ago) |
| Identification Number: | 001765809 |
| Principal Address: | 8204 LISA LN, SMYRNA, TN, 37167, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932983590 | 2023-08-23 | 2023-08-23 | 8204 LISA LN, SMYRNA, TN, 371673364, US | 320 PHILLIPS ST FL 1, NORTH KINGSTOWN, RI, 028525166, US | |||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 401-206-0715 |
Authorized person
| Name | DERRYL NOWAK |
| Role | COO |
| Phone | 4012060715 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | No |
| Taxonomy Code | 171000000X - Military Health Care Provider |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 225700000X - Massage Therapist |
| Is Primary | No |
| Taxonomy Code | 261QP3300X - Pain Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QV0200X - VA Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| DERRYL NOWAK | Agent | 320 PHILLIPS ST, NORTH KINGSTOWN, RI, 02852, USA |
| Name | Role | Address |
|---|---|---|
| DERRYL NOWAK | Manager | 8204 LISA LN SMYRNA, TN 37167 US |
| Number | Name | File Date |
|---|---|---|
| 202447735150 | Revocation Certificate For Failure to Maintain a Registered Office | 2024-03-04 |
| 202343550370 | Revocation Notice For Failure to Maintain a Registered Office | 2023-12-26 |
| 202342942770 | Articles of Organization | 2023-11-27 |
Date of last update: 29 Oct 2024
Sources: Rhode Island Department of State
