Provider Demographics
NPI:1831284587
Name:JOHNSON, KANDACE FAYE (DC)
Entity Type:Individual
Prefix:DR
First Name:KANDACE
Middle Name:FAYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 VICTORIA DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386
Mailing Address - Country:US
Mailing Address - Phone:952-448-9000
Mailing Address - Fax:952-448-4901
Practice Address - Street 1:7924 VICTORIA DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-0156
Practice Address - Country:US
Practice Address - Phone:952-448-9000
Practice Address - Fax:952-448-4901
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor