=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457958068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPGRADES IN HEALTH AND WELLNESS COASTAL HYPERBARIC HARRIET SEGELCKE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2020
-----------------------------------------------------
Last Update Date | 04/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 CABRILLO HWY S STE 110D
-----------------------------------------------------
City | HALF MOON BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94019-1738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-384-1186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 CABRILLO HWY S STE 110D
-----------------------------------------------------
City | HALF MOON BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94019-1738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-384-1186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HARRIET SEGELCKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-703-0583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------