Healthcare Provider Details

I. General information

NPI: 1154209534
Provider Name (Legal Business Name): MITCHELL SHANE LAMERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W KING ST STE A
KINGS MOUNTAIN NC
28086-3310
US

IV. Provider business mailing address

510 W KING ST STE A
KINGS MOUNTAIN NC
28086-3310
US

V. Phone/Fax

Practice location:
  • Phone: 980-396-2811
  • Fax:
Mailing address:
  • Phone: 980-396-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5952
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: