| Name: | Revive Integrative & Functional Medicine PC |
| Jurisdiction: | Idaho |
| Legal type: | Professional Service Corporation (D) |
| Status: | Inactive-Dissolved (Administrative) |
| Date of registration: | 31 Mar 2023 (2 years ago) |
| Financial Date End: | 31 Mar 2024 |
| Date dissolved: | 12 Jun 2024 |
| Entity Number: | 5172807 |
| Place of Formation: | IDAHO |
| File Number: | 871781 |
| ZIP code: | 83406 |
| County: | Bonneville County |
| Mailing Address: | GAYLENE ADAMS 3722 S HAZEN DR AMMON, ID 83406-1234 |
| Name | Role | Address |
|---|---|---|
| Gaylene Ann Adams | Agent | 2270 S HAZEN DRIVE, IDAHO FALLS, ID 83404 |
| Filing Name | Filing Number | Filing date |
|---|---|---|
| Dissolution/Revocation - Administrative | 0005777887 | 2024-06-12 |
| Initial Filing | 0005172807 | 2023-03-31 |
Date of last update: 08 Jan 2025
Sources: Idaho Secretary of State
