Provider Demographics
NPI:1568823920
Name:REVYV ME LLC
Entity Type:Organization
Organization Name:REVYV ME LLC
Other - Org Name:REVYVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WES
Authorized Official - Middle Name:
Authorized Official - Last Name:RACHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-975-0162
Mailing Address - Street 1:2540 KING ARTHUR BLVD #206
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4740 STATE HWY 121 #200
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056
Practice Address - Country:US
Practice Address - Phone:972-975-0162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0011572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty