DANE JACK CHURCH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

ACTIVE

Business

Title

First Name

DANE

Middle

JACK

Last Name

CHURCH

Business Name

DANE JACK CHURCH MD

Original Issue Date

04/19/2019

Effective Date

05/02/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2023