Provider Demographics
NPI:1386487296
Name:MEKOBA, PROSPER CHIDERA (DC)
Entity type:Individual
Prefix:
First Name:PROSPER
Middle Name:CHIDERA
Last Name:MEKOBA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101031
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33310-1031
Mailing Address - Country:US
Mailing Address - Phone:347-369-6494
Mailing Address - Fax:
Practice Address - Street 1:7815 NW BEACON SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1345
Practice Address - Country:US
Practice Address - Phone:561-455-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHF14521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor