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State Board of Chiropractic Examiners
CHIRO Home
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Chiropractic Applicants, Licensing and Registration
Chiropractors
Doctor of Chiropractic License Application
Unofficial Copies of Undergraduate Transcript and Chiropractic Transcript (Official Transcripts must be requested to be sent directly to this Board)
Certificate of Moral Character x 2 (sent to board by D.C timely)
Copy of Provider Level CPR
Criminal History Records Check - Fingerprinting Instructions
MD Fingerprinting Form - In State Only
Out of State Fingerprinting MUST contact Board of Fingerprint Card first
D.C. Application for Re-examination
Special Accommodations Request
(Requires medical/school documentation)
Licensed Chiropractors
Application for Licensure by Waiver for Visiting Chiropractor
Application for Licensure by Credentials
Continuing Education Guidelines and Forms
Extern Application
Preceptor Application
Preceptor’s Final Evaluation
Application for Reactivation/Reinstatement – Please submit a written request to the Board.
Interim Chiropractic Assistant Application (for DC graduate students ONLY)
Supervising Chiropractor Application
Chiropractic Assistant Applicants
CA Training Program Guide
Stage 1
- (4 page packet with all required documents must be submitted)
CA Training Program Outline Guide
CA Applicant/Trainee Request to Employ
- Application Packet
Supervising D.C. (Pages 1 & 2 to complete)
CA Trainee (Pages 3 & 4 to complete)
Copy of Birth Cert.
Copy of D. L
Copy of High School Diploma (foreign schooling requires translation/evaluation)
Copy of Authorization to Work (Work Permit if applicable)
Notification of Hiring an Active Registered CA
(faxed directly to the Board)
Change of Status
(for CA Applicants and Registered CAs)
Notice of Transfer
(for CA Applicants and Registered CAs)
Stage 2
4 Month Review Form
Form MUST include copy of CPR certification and Proof of enrollment in Board approved CA Instructional Coursework
Stage 3
-
the following application (with all required fees and documentation) must be
remitted by the deadline date complete.
CA Application for Registration
Certificate of Moral Character
Clinical Training Log
Certificate of 103 CA Coursework completion
Provider Level CPR (should have been submitted at 4 month review)
Criminal History Record Check - Fingerprinting (copy of receipt)
Application for Re-examination
(for CA Applicant/Trainee)
Special Accommodations Request
(Requires medical/school documentation)
Additional Forms
Complaint Form
Notification of Name/Address Change
Request for Replacement License
Request for License Verification
Request for Duplicate License
Special Accommodations Request
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