Healthcare Provider Details

I. General information

NPI: 1053716852
Provider Name (Legal Business Name): JOHN-MICHAEL KEONI DELLERMANN DC, CCSP, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 WASHINGTON BLVD STE 208
OGDEN UT
84401-3623
US

IV. Provider business mailing address

2275 N 2100 E
LAYTON UT
84040-8084
US

V. Phone/Fax

Practice location:
  • Phone: 801-200-3654
  • Fax:
Mailing address:
  • Phone: 801-200-3654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number12884926-1202
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number12884926-4810
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: