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General NPI Number Information
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NPI Number | 1831049592
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Entity Type | Organization
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Legal Business Name | IDAHO NEURO DYNAMICS LLC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 901 SPRUCE ST APT A
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City | SANDPOINT
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State | ID
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Zip | 83864-5024
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Country | US
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Telephone | 208-603-9946
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Fax |
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Provider Business Mailing Address
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Address Line | 901 SPRUCE ST APT A
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City | SANDPOINT
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State | ID
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Zip | 83864-5024
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Country | US
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Telephone | 208-603-9946
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Fax |
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Authorized Official
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Title or Position | CEO/MEDICAL DIRECTOR
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Name | MR. JOHN DEWIG
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Credential | MS, LMFT, QEEG-DL
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Telephone | 208-603-9946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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