TRAVIS GENE BROADFIELD IDPR Registered License verification

Business Entity

NOT RENEWED

License Type

IDPR Registered

Description

CERTIFIED EUTHANASIA TECHNICIAN

License Number

235000077

License Status

NOT RENEWED

Business

First Name

TRAVIS

Middle

GENE

Last Name

BROADFIELD

Business Name

TRAVIS GENE BROADFIELD

Original Issue Date

03/09/2006

Effective Date

03/09/2006

Expiration Date

04/30/2008

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

06/04/2008