Provider Demographics
NPI:1871118489
Name:ROMMELFANGER, MAKENNA (DC)
Entity type:Individual
Prefix:DR
First Name:MAKENNA
Middle Name:
Last Name:ROMMELFANGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:MAKENNA
Other - Middle Name:
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:19059 GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1208
Mailing Address - Country:US
Mailing Address - Phone:402-253-5036
Mailing Address - Fax:
Practice Address - Street 1:16918 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4088
Practice Address - Country:US
Practice Address - Phone:402-206-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor