Provider Demographics
NPI:1114178936
Name:ITR INCORPORATED
Entity Type:Organization
Organization Name:ITR INCORPORATED
Other - Org Name:IMAGINE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VITA
Authorized Official - Middle Name:KRISTINA
Authorized Official - Last Name:SIMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-709-3900
Mailing Address - Street 1:115 N 10TH ST
Mailing Address - Street 2:SUITE B-105
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-2703
Mailing Address - Country:US
Mailing Address - Phone:479-709-3900
Mailing Address - Fax:479-709-3901
Practice Address - Street 1:115 N 10TH ST
Practice Address - Street 2:SUITE B-105
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-2703
Practice Address - Country:US
Practice Address - Phone:479-709-3900
Practice Address - Fax:479-709-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty