Healthcare Provider Details

I. General information

NPI: 1831046721
Provider Name (Legal Business Name): NICOLLE PISMAROV D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S SEPULVEDA BLVD STE 247
MANHATTAN BEACH CA
90266-6876
US

IV. Provider business mailing address

400 S SEPULVEDA BLVD STE 200
MANHATTAN BEACH CA
90266-6876
US

V. Phone/Fax

Practice location:
  • Phone: 310-798-6496
  • Fax:
Mailing address:
  • Phone: 424-212-8500
  • Fax: 424-212-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC37359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: