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General NPI Number Information
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NPI Number | 1316120272
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Entity Type | Organization
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Legal Business Name | POWER OF LIFE CHIROPRACTIC, P.A.
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 1700 STIEGER LAKE LN STE 103
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City | VICTORIA
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State | MN
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Zip | 55386-7721
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Country | US
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Telephone | 952-443-9000
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Fax | 952-448-4901
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Provider Business Mailing Address
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Address Line | PO BOX 156
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City | VICTORIA
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State | MN
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Zip | 55386-0156
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Country | US
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Telephone | 952-448-9000
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Fax | 952-448-4901
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KANDACE FAYE JOHNSON
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Credential | D.C.
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Telephone | 952-448-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4834
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License Number State | MN
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