HERBERT JACKSON Podiatrist License verification

Business Entity

INACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016002434

License Status

INACTIVE

Business

First Name

HERBERT

Last Name

JACKSON

Business Name

HERBERT JACKSON

Original Issue Date

08/01/1962

Effective Date

08/01/1962

Expiration Date

01/31/2005

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/09/2006