Healthcare Provider Details

I. General information

NPI: 1437072600
Provider Name (Legal Business Name): NEUROLYTE DX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 N 700 W. #102
LINDON UT
84042
US

IV. Provider business mailing address

1971 N 700 W.
LINDON UT
84042
US

V. Phone/Fax

Practice location:
  • Phone: 801-697-6006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: IAN DAWE
Title or Position: DIRECTOR
Credential: APRN
Phone: 801-697-6006