Provider Demographics
NPI:1053716852
Name:DELLERMANN, JOHN-MICHAEL KEONI (DC, CCSP, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:JOHN-MICHAEL
Middle Name:KEONI
Last Name:DELLERMANN
Suffix:
Gender:M
Credentials:DC, CCSP, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 N 2100 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-8084
Mailing Address - Country:US
Mailing Address - Phone:801-200-3654
Mailing Address - Fax:
Practice Address - Street 1:2650 WASHINGTON BLVD STE 208
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-3623
Practice Address - Country:US
Practice Address - Phone:801-200-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12884926-48102255A2300X
UT12884926-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer