Provider Demographics
NPI:1154209534
Name:LAMERSON, MITCH SHANE (DC)
Entity type:Individual
Prefix:DR
First Name:MITCH
Middle Name:SHANE
Last Name:LAMERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W KING ST STE A
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3310
Mailing Address - Country:US
Mailing Address - Phone:980-396-2811
Mailing Address - Fax:
Practice Address - Street 1:510 W KING ST STE A
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3310
Practice Address - Country:US
Practice Address - Phone:980-396-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor