MEDICARE: POWER OF LIFE CHIROPRACTIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4834	MN

General Provider Information

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

Provider Business Mailing Address
First Line	:	PO BOX 156
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-0156
Country	:	US
Telephone Number	:	952-448-9000
Fax Number	:	952-448-4901

Provider Business Practice Location Address
First Line	:	1700 STIEGER LAKE LN STE 103
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-7721
Country	:	US
Telephone Number	:	952-443-9000
Fax Number	:	952-448-4901

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KANDACE FAYE JOHNSON
Credential	:	D.C.
Telephone Number	:	952-448-9000

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	03/05/2025

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