Healthcare Provider Details

I. General information

NPI: 1245140557
Provider Name (Legal Business Name): MBS CHIROPRACTIC & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NASH ST STE 140
BRYAN TX
77802-1163
US

IV. Provider business mailing address

2751 NASH ST STE 140
BRYAN TX
77802-1163
US

V. Phone/Fax

Practice location:
  • Phone: 979-485-1346
  • Fax:
Mailing address:
  • Phone: 979-485-1346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: GERARDO BUSTAMANTE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 979-485-1346