Healthcare Provider Details

I. General information

NPI: 1316120272
Provider Name (Legal Business Name): POWER OF LIFE CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 STIEGER LAKE LN STE 103
VICTORIA MN
55386-7721
US

IV. Provider business mailing address

PO BOX 156
VICTORIA MN
55386-0156
US

V. Phone/Fax

Practice location:
  • Phone: 952-443-9000
  • Fax: 952-448-4901
Mailing address:
  • Phone: 952-448-9000
  • Fax: 952-448-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4834
License Number StateMN

VIII. Authorized Official

Name: DR. KANDACE FAYE JOHNSON
Title or Position: PRESIDENT
Credential: D.C.
Phone: 952-448-9000