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  5. NORTHERN LIGHTS PAIN MANAGEMENT, LLC

NORTHERN LIGHTS PAIN MANAGEMENT, LLC

Contents

Company Details

Name: NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Jurisdiction: Alaska
Legal type: Limited Liability Company
Status: Good Standing
Date of registration: 04 Dec 2003 (21 years ago)
Expiration date: 04 Dec 2050
Entity Number: 83891D
ZIP code: 99709
County: Fairbanks North Star
Place of Formation: ALASKA
Address: 3455 REWAK DR STE 102, FAIRBANKS, AK 99709

Activity

Line of Business

62 Health Care and Social Assistance

NAICS

621111 OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)

Officers

Name Role
ROBERT VALENTZ Registered Agent
Robert F Valentz Member

Form 5500

Plan Name Plan Year EIN/PN Received Total number of participants
NORTHERN LIGHTS PAIN MANAGEMENT 401(K) PLAN 2023 721576496 2024-05-24 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Business code 621399
Sponsor’s telephone number 9074522947
Plan sponsor’s address 3455 REWAK DRIVE, SUITE 102, FAIRBANKS, AK, 99709

Signature of
Role Plan administrator
Date 2024-05-24
Name of individual signing ROBERT VALENTZ
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PAIN MANAGEMENT 401(K) PLAN 2023 721576496 2024-07-19 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Business code 621399
Sponsor’s telephone number 9074522947
Plan sponsor’s address 3455 REWAK DRIVE, SUITE 102, FAIRBANKS, AK, 99709

Signature of
Role Plan administrator
Date 2024-07-19
Name of individual signing ROBERT VALENTZ
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PAIN MANAGEMENT 401(K) PLAN 2022 721576496 2023-07-03 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Business code 621399
Sponsor’s telephone number 9074522947
Plan sponsor’s address 3455 REWAK DRIVE, SUITE 102, FAIRBANKS, AK, 99709

Signature of
Role Plan administrator
Date 2023-07-03
Name of individual signing ROBERT VALENTZ
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PAIN MANAGEMENT 401(K) PLAN 2021 721576496 2022-07-14 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Business code 621399
Sponsor’s telephone number 9074522947
Plan sponsor’s address 3455 REWAK DRIVE, SUITE 102, FAIRBANKS, AK, 99709

Signature of
Role Plan administrator
Date 2022-07-14
Name of individual signing ROBERT VALENTZ
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PAIN MANAGEMENT 401(K) PLAN 2020 721576496 2021-07-29 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Business code 621399
Sponsor’s telephone number 9074522947
Plan sponsor’s address 3455 REWAK DRIVE, SUITE 102, FAIRBANKS, AK, 99709

Signature of
Role Plan administrator
Date 2021-07-29
Name of individual signing ROBERT VALENTZ
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PAIN MANAGEMENT 401(K) PLAN 2019 721576496 2020-08-20 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Business code 621399
Sponsor’s telephone number 9074522947
Plan sponsor’s address 3455 REWAK DRIVE, SUITE 102, FAIRBANKS, AK, 99709

Signature of
Role Plan administrator
Date 2020-08-20
Name of individual signing ROBERT VALENTZ
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PAIN MANAGEMENT 401(K) PLAN 2018 721576496 2019-09-06 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Business code 621399
Sponsor’s telephone number 9074522947
Plan sponsor’s address 3455 REWAK DRIVE, SUITE 102, FAIRBANKS, AK, 99709

Signature of
Role Plan administrator
Date 2019-09-06
Name of individual signing ROBERT VALENTZ
Valid signature Filed with authorized/valid electronic signature
NORTHERN LIGHTS PAIN MANAGEMENT 401(K) PLAN 2017 721576496 2019-01-16 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2017-01-01
Sponsor NORTHERN LIGHTS PAIN MANAGEMENT, LLC
Business code 621399
Sponsor’s telephone number 9074522947
Plan sponsor’s address 3455 REWAK DRIVE, SUITE 102, FAIRBANKS, AK, 99709

Signature of
Role Plan administrator
Date 2019-01-16
Name of individual signing ROBERT VALENTZ
Valid signature Filed with authorized/valid electronic signature

Licenses

Type License Number Status Date of issue Date of renewal Expiration date Description
Business License 297874 Active 2003-12-19 2022-10-24 2024-12-31 LOB: 62 - Health Care and Social Assistance, NAICS: 621111 - OFFICES OF PHYSICIANS (EXCEPT MENTAL HEALTH SPECIALISTS)
Telemedicine Business Registry 160670 Active 2020-04-16 - - -

Date of last update: 11 Jan 2025

Sources: State of Alaska - Department of Commerce, Community, and Economic Development

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