Healthcare Provider Details

I. General information

NPI: 1972742120
Provider Name (Legal Business Name): JOEL A. CLIPPERTON R. EEG T., CLTM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7557 E WARREN CIR APT 5-108
DENVER CO
80231-5346
US

IV. Provider business mailing address

7557 E WARREN CIR APT 5-108
DENVER CO
80231-5346
US

V. Phone/Fax

Practice location:
  • Phone: 949-238-4887
  • Fax:
Mailing address:
  • Phone: 949-238-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number4505
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number4505
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: