Healthcare Provider Details

I. General information

NPI: 1801010806
Provider Name (Legal Business Name): CROSSROADS PREMIERE HEALTH CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 SW THIRD STREET
CORVALLIS OR
97333
US

IV. Provider business mailing address

1760 SW THIRD STREET
CORVALLIS OR
97333
US

V. Phone/Fax

Practice location:
  • Phone: 541-207-3773
  • Fax: 800-549-1017
Mailing address:
  • Phone: 541-224-2077
  • Fax: 800-549-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberD028866
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD028866
License Number StateOR

VIII. Authorized Official

Name: SANDRA LEE SLESZYNSKI
Title or Position: PRESIDENT
Credential: DO
Phone: 541-224-2077