Organization
REVLIS MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MCKEOWN DC (MANAGER)
(845) 551-8166
Entity
Organization
Contact information
Practice address
1040 EDGEWATER PKWY STE 104, SUITE 104, INDIAN LAND, SC 29707-4526
(845) 551-8166
Mailing address
1040 EDGEWATER PKWY, SUITE 104, INDIAN LAND, SC 29707-4526
(845) 551-8166
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X010814
NY LICENSE #
NY
Enumeration date
04/07/2021
Last updated
04/22/2024
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