Provider Demographics
NPI:1316120272
Name:POWER OF LIFE CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:POWER OF LIFE CHIROPRACTIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANDACE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-448-9000
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-0156
Mailing Address - Country:US
Mailing Address - Phone:952-448-9000
Mailing Address - Fax:952-448-4901
Practice Address - Street 1:1700 STIEGER LAKE LN STE 103
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-7721
Practice Address - Country:US
Practice Address - Phone:952-443-9000
Practice Address - Fax:952-448-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty