MEDICARE: KEN BELLER AC

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1114749843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEN BELLER AC

Provider Business Mailing Address
First Line	:	75 RED ROCK CROSSING RD
Second Line	:
City	:	SEDONA
State	:	AZ
Zip	:	86336-9761
Country	:	US
Telephone Number	:	928-204-9232
Fax Number	:	928-204-9230

Provider Business Practice Location Address
First Line	:	75 RED ROCK CROSSING RD
Second Line	:
City	:	SEDONA
State	:	AZ
Zip	:	86336-9761
Country	:	US
Telephone Number	:	928-204-9232
Fax Number	:	928-204-9230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2024
Last Update Date	:	10/24/2024

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