CHAD R JUSTESEN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

First Name

CHAD R

Last Name

JUSTESEN

Business Name

CHAD R JUSTESEN

Original Issue Date

11/13/1997

Effective Date

11/13/1997

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006