All States and the District of Columbia regulate the practice of chiropractic and grant licenses to chiropractors who meet educational and examination requirements established by the State. Chiropractors can practice only in States where they are licensed. Some States have agreements permitting chiropractors licensed in one State to obtain a license in another without further examination, provided that their educational, examination, and practice credentials meet State specifications.

   Most State boards require at least 2 years of undergraduate education; an increasing number are requiring a 4-year bachelor’s degree. All boards require the completion of a 4-year program at an accredited chiropractic college leading to the Doctor of Chiropractic degree.

   For licensure, most State boards recognize either all or part of the four-part test administered by the National Board of Chiropractic Examiners. State examinations may supplement the National Board tests, depending on State requirements.

  To maintain licensure, almost all States require the completion of a specified number of hours of continuing education each year. Chiropractic associations and accredited chiropractic programs and institutions offer continuing education programs. Specialty councils within some chiropractic associations also offer programs leading to clinical specialty certification, called “diplomate” certification, in areas such as orthopedics, neurology, sports injuries, occupational and industrial health, nutrition, diagnostic imaging, thermography, and internal disorders.

   In 2003, 16 chiropractic programs and 2 chiropractic institutions in the United States were accredited by the Council on Chiropractic Education. Applicants are required to have at least 90 semester hours of undergraduate study leading toward a bachelor’s degree, including courses in English, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor’s degree, which may eventually become the minimum entry requirement. Several chiropractic colleges offer prechiropractic study, as well as a bachelor’s degree program. Recognition of prechiropractic education offered by chiropractic colleges varies among the State boards.

  During the first 2 years, most chiropractic programs emphasize classroom and laboratory work in basic science subjects such as anatomy, physiology, public health, microbiology, pathology, and biochemistry. The last 2 years stress courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition. Chiropractic programs and institutions grant the degree of Doctor of Chiropractic.

  Chiropractic requires keen observation to detect physical abnormalities. It also takes considerable manual dexterity, but not unusual strength or endurance, to perform adjustments. Chiropractors should be able to work independently and handle responsibility. As in other health-related occupations, empathy, understanding, and the desire to help others are good qualities for dealing effectively with patients.

  Newly licensed chiropractors can set up a new practice, purchase an established one, or enter into partnership with an established practitioner. They also may take a salaried position with an established chiropractor, a group practice, or a healthcare facility.