Healthcare Provider Details

I. General information

NPI: 1386487296
Provider Name (Legal Business Name): PROSPER CHIDERA MEKOBA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7815 NW BEACON SQUARE BLVD
BOCA RATON FL
33487-1345
US

IV. Provider business mailing address

PO BOX 101031
FT LAUDERDALE FL
33310-1031
US

V. Phone/Fax

Practice location:
  • Phone: 561-455-4850
  • Fax:
Mailing address:
  • Phone: 347-369-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHF14521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: