Healthcare Provider Details

I. General information

NPI: 1831284587
Provider Name (Legal Business Name): KANDACE FAYE JOHNSON D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7924 VICTORIA DRIVE SUITE 202
VICTORIA MN
55386-0156
US

IV. Provider business mailing address

7924 VICTORIA DRIVE SUITE 202
VICTORIA MN
55386
US

V. Phone/Fax

Practice location:
  • Phone: 952-448-9000
  • 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:
Title or Position:
Credential:
Phone: