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COEUR D'ALENE SPINE AND BRAIN, PLLC

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Company Details

Name: COEUR D'ALENE SPINE AND BRAIN, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 03 Mar 2003 (22 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 82449
Place of Formation: IDAHO
File Number: 82449
ZIP code: 83814
County: Kootenai County
Principal Address: 3320 N GRAND MILL LANE COEUR D'ALENE, ID 83814
Mailing Address: 3320 N GRAND MILL LN COEUR D ALENE, ID 83814-5689

Member

Name Role Address Appointed On
Jeffrey J Larson Member 3766 W SHOREVIEW LANE, COEUR D ALENE, ID 83814 2021-03-16

Agent

Name Role Address
JEFFREY J LARSON Agent 3320 N GRAND MILL LN, COEUR D ALENE, ID 83314

National Provider Identifier

NPI Number:
1588714489
Certification Date:
2023-02-23

Authorized Person:

Name:
LISA RAE TANSY
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
174400000X - Specialist
Is Primary:
Yes

Contacts:

Fax:
2087659103

Form 5500 Series

Employer Identification Number (EIN):
571155831
Plan Year:
2023
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
14
Sponsors Telephone Number:
Plan Year:
2023
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
16
Sponsors Telephone Number:
Plan Year:
2022
Number Of Participants:
15
Sponsors Telephone Number:

Filing

Filing Name Filing Number Filing date
Annual Report 0006136363 2025-03-03
Annual Report 0005590731 2024-02-07
Annual Report 0005165149 2023-03-22
Annual Report 0004661257 2022-03-15
Annual Report 0004211168 2021-03-16

Paycheck Protection Program

Jobs Reported:
9
Initial Approval Amount:
$144,815
Date Approved:
2020-04-06
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$144,815
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$145,616.44
Servicing Lender:
Glacier Bank
Use of Proceeds:
Payroll: $144,815

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Date of last update: 14 Jul 2025

Sources: Idaho Secretary of State