Healthcare Provider Details

I. General information

NPI: 1720943897
Provider Name (Legal Business Name): DANNY PARISH JR. BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 SUNSET DR
FARMINGTON MO
63640
US

IV. Provider business mailing address

1355 RIDGE TOP DR
FARMINGTON MO
63640-7971
US

V. Phone/Fax

Practice location:
  • Phone: 573-747-1144
  • Fax: 573-747-1143
Mailing address:
  • Phone: 573-747-1144
  • Fax: 573-747-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC51166
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: