Provider Demographics
NPI:1538766399
Name:UTUK, MEKEME (DC)
Entity type:Individual
Prefix:DR
First Name:MEKEME
Middle Name:
Last Name:UTUK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TIFFANY LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3819
Mailing Address - Country:US
Mailing Address - Phone:609-506-0095
Mailing Address - Fax:
Practice Address - Street 1:2808 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1207
Practice Address - Country:US
Practice Address - Phone:215-637-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00771800111N00000X
PADC011577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor