MEDICARE: CHATEAU SPINAL REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	006757	GA
2	261QP2000X	Physical Therapy Clinic/Center	052852	GA

General Provider Information

NPI Number	:	1669536082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATEAU SPINAL REHAB

Provider Business Mailing Address
First Line	:	2095 HIGHWAY 211 NW
Second Line	:	SUITE 2-F #105
City	:	BRASELTON
State	:	GA
Zip	:	30517-3402
Country	:	US
Telephone Number	:	770-307-0968
Fax Number	:	770-868-0598

Provider Business Practice Location Address
First Line	:	2095 HIGHWAY 211 NW
Second Line	:	SUITE 3A
City	:	BRASELTON
State	:	GA
Zip	:	30517-3402
Country	:	US
Telephone Number	:	770-307-0968
Fax Number	:	770-868-0598

Authorized Official
Title or Position	:	OWNER
Name	:	GARY R ADAMS
Credential	:	DC
Telephone Number	:	770-307-0968

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/11/2025

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Directions to “CHATEAU SPINAL REHAB ” Practice Location

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