KIRK D BROCK Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****97

License Status

NOT RENEWED

Business

First Name

KIRK D

Last Name

BROCK

Business Name

KIRK D BROCK

Original Issue Date

06/24/1991

Effective Date

01/30/2017

Expiration Date

01/31/2019

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/28/2019