RANDALL HEISNER DC Athletics Professional License verification

Business Entity

NOT RENEWED

License Type

Athletics Professional

Description

ATHLETICS - LICENSED PHYSICIAN

License Number

002020147-0002

License Status

NOT RENEWED

Business

First Name

RANDALL

Last Name

HEISNER

Suffix

Business Name

RANDALL HEISNER DC

Original Issue Date

02/26/1975

Effective Date

02/26/1975

Expiration Date

02/26/1976

City

FAIRFIELD

State

Zip

67837

County

WAYNE

Ever Disciplined

LastModifiedDate

09/18/2006