In New York, the practice of chiropractic is legally defined as detecting and correcting structural imbalance, distortion, or subluxations in the human body by manual or mechanical means to remove nerve interference and its effects related to the vertebral column 1.2 As a licensed health care profession, chiropractic is subject to a robust regulatory framework established to protect public health and safety. The governance of the profession is codified in state law, specifically within Article 132 of the New York State Education Law 3, which outlines the requirements for licensure, defines the scope of practice, and establishes the grounds for professional misconduct. This structured oversight by the New York State Education Department 4 ensures that every individual granted a license to practice has met objective, verifiable standards of education, competency, and ethical conduct. This modern, regulated environment stands in contrast to the profession's formative years, which were characterized by a struggle for legal recognition on a state-by-state basis, a history documented by early proponents such as D.D. Palmer 5.
The pathway to becoming a licensed chiropractor in New York is a multi-stage process designed to build a foundation of scientific knowledge and clinical skill. The journey begins with a significant pre-professional academic requirement, mandating that applicants complete a minimum of 90 semester hours of undergraduate college study 6. Following this, candidates must graduate from a registered or accredited doctor of chiropractic program. A central component of the licensure process is the successful completion of a series of rigorous examinations administered by the National Board of Chiropractic Examiners (NBCE). Candidates must pass Part I, which assesses proficiency in six foundational science subjects including General Anatomy, Spinal Anatomy, Physiology, and Pathology 7. They must also pass Part II, which covers six clinical science subjects such as General Diagnosis, Neuromusculoskeletal Diagnosis, and Diagnostic Imaging 8.
Furthermore, applicants must demonstrate clinical competency by passing the NBCE's Part III written examination, which evaluates nine critical domains including Case History, Physical Examination, and Neuromusculoskeletal Examination 9. For chiropractors who intend to incorporate adjunctive procedures into their practice, passing the NBCE's Physiotherapy (PT) examination is also required; this exam assesses knowledge of thermal, light, sound, electrical, and mechanical therapies 10. Once licensed, practitioners must engage in continuous professional development, with New York mandating the completion of 36 hours of continuing education every three years 11. This regulatory structure, from initial education to ongoing professional maintenance, is reinforced by systems that track professional conduct, such as the Chiropractic Information Network-Board Action Databank (CIN-BAD), a repository of public disciplinary actions used by licensing boards to ensure accountability 12.
Governing authority and legal framework
The regulation of the chiropractic profession in New York is administered by the New York State Education Department (NYSED), a state agency responsible for overseeing public education and the licensed professions 4. Within this structure, the New York State Board for Chiropractic functions as an advisory and assistance body. The State Board is composed of licensed chiropractors and public representatives appointed by the Board of Regents. Each state board for the professions assists the Board of Regents and the New York State Education Department on matters of professional regulation, including preparing and conducting licensing examinations, reviewing qualifications, and investigating professional misconduct. 13. The board's work ensures that the legal and ethical parameters governing the profession are appropriately implemented and enforced.
The foundational legal statute governing chiropractic in the state is New York State Education Law, Article 132 3. This article provides the comprehensive legal framework that defines the profession, specifies the requirements for obtaining and maintaining a license, and delineates the lawful scope of chiropractic practice. Enacted to safeguard public health and welfare, Article 132 establishes that only individuals who meet rigorous educational, examination, and character standards may be licensed to practice chiropractic in New York. This codification is the culmination of historical efforts by the chiropractic community to achieve legal recognition and a defined professional status, a process that unfolded differently across various states throughout the 20th century, as documented in works like The official history of chiropractic in Texas 14.
A critical element of Article 132 is its specific definition of the practice of chiropractic. The law states that the practice involves "detecting and correcting structural imbalance, distortion, or subluxations in the human body by manual or mechanical means" 1. The explicit goal of these procedures is "to remove nerve interference and its effects," with the scope of practice primarily focused on conditions "related to the vertebral column" 31. This definition legally establishes the chiropractor's professional domain and distinguishes it from other healthcare disciplines. Under this statute, chiropractors are authorized to use diagnostic methods such as physical examinations, neurological and orthopedic tests, and x-ray imaging specifically for the purpose of analyzing the spine and locating subluxations. The law also permits the use of analytical instruments and manual or mechanical adjustment techniques consistent with chiropractic principles.
While defining what is permitted, Article 132 also sets clear boundaries on the scope of practice. For example, chiropractors in New York are expressly prohibited from prescribing legend drugs or controlled substances, performing surgery, reducing fractures or dislocations, or treating infectious diseases, cancer, or cardiovascular disease, among other conditions. The State Board for Chiropractic, under the authority of NYSED, is responsible for enforcing these provisions 4. This includes reviewing licensure applications, overseeing examinations, and investigating allegations of professional misconduct. When misconduct is confirmed, the Board recommends disciplinary actions to the Board of Regents, which may include censure, fines, license suspension, or revocation. This system of governance and legal oversight ensures that all licensed chiropractors in New York adhere to the standards of competence and ethics prescribed by state law.
Educational prerequisites: Pre-professional and doctoral studies
The path to becoming a licensed chiropractor in New York is built upon a specific and rigorous educational foundation mandated by the New York State Education Department (NYSED) 4. Before an individual can be considered for licensure, they must satisfy two primary educational stages: pre-professional undergraduate coursework and a professional doctoral degree program. The first stage requires the completion of at least 90 semester hours of pre-professional college study at an accredited institution 6. This coursework must provide a broad foundation in the liberal arts and sciences, with a significant concentration in disciplines that prepare the student for advanced medical and clinical studies. The curriculum is designed to ensure competency in the foundational sciences that underpin chiropractic practice. These undergraduate courses in biology, general and organic chemistry, and physics are essential for mastering the subjects assessed in Part I of the National Board of Chiropractic Examiners (NBCE) examination, which includes General Anatomy, Spinal Anatomy, Physiology, Chemistry, Pathology, and Microbiology 7.
Following the successful completion of pre-professional studies, a candidate must earn a Doctor of Chiropractic (D.C.) degree. New York State law specifies that this degree must be conferred by a program either registered by the NYSED or accredited by the Council on Chiropractic Education (CCE), the national agency recognized for this purpose 6. CCE accreditation ensures that chiropractic programs meet stringent standards for curriculum, faculty, facilities, and student outcomes. The D.C. program is a demanding, four-academic-year course of study, typically comprising a minimum of 4,200 instructional hours. This modern, science-based curriculum represents a significant evolution from the profession's early educational models, a transformation chronicled in works like David D. Palmer's Three generations: a history of chiropractic 15.
The D.C. curriculum is bifurcated into basic sciences and clinical sciences. The initial years are dedicated to advanced classroom and laboratory instruction in subjects like human anatomy and physiology, biochemistry, microbiology, pathology, and public health. The latter half of the program shifts focus to clinical education, with courses in diagnosis, diagnostic imaging, and chiropractic principles and practice. These subjects are directly aligned with the content of the NBCE Part II examination, which assesses General Diagnosis, Neuromusculoskeletal Diagnosis, Diagnostic Imaging, and Principles of Chiropractic 8. A substantial portion of the doctoral program involves supervised clinical training in an internship setting. Here, students gain hands-on experience in patient assessment, case management, and the application of manual adjustive procedures, such as those described in classic works like F. P. DeGiacomo's Textbook of chiropractic technique. This integrated educational pathway, combining 90 hours of foundational undergraduate work with a CCE-accredited doctoral degree, is the mandatory prerequisite before a candidate may proceed with the required national and state examinations for New York licensure 16.
National Board Examinations Part I and Part II: Foundational and clinical sciences
The path to chiropractic licensure in New York requires candidates to pass a rigorous, multi-part series of examinations administered by the National Board of Chiropractic Examiners (NBCE). The initial stage of this national testing sequence consists of Part I and Part II, which are computer-based, multiple-choice examinations designed to assess a candidate's mastery of the foundational and clinical sciences. These exams establish a standardized measure of theoretical knowledge for all aspiring chiropractors in the United States. Successful completion of both Part I and Part II is a mandatory prerequisite before a candidate is eligible to sit for the subsequent clinical competency examinations required by the New York State Education Department 4.
The NBCE Part I examination is typically taken after a student has completed the second year of a doctoral program. Its purpose is to evaluate comprehension of the basic sciences that form the bedrock of medical and chiropractic education. The exam is divided into six subject areas: General Anatomy, Spinal Anatomy, Physiology, Chemistry, Pathology, and Microbiology 7. The inclusion of dedicated sections on General and Spinal Anatomy reflects the profession's specific focus on the human body's structure, particularly the vertebral column, as it relates to the detection and correction of structural imbalances or subluxations 1. Subjects like Physiology and Pathology test the candidate's understanding of normal bodily function and the nature of disease, respectively. This standardized assessment of scientific principles ensures that all candidates possess the necessary academic foundation before progressing to more advanced clinical studies, a significant evolution from the more philosophically grounded origins of the profession detailed in early texts like D. D. Palmer's The Chiropractor 5.
Following the successful completion of Part I, candidates advance to the NBCE Part II examination, which is generally taken during the third year of chiropractic college. This exam shifts the focus from basic sciences to their application in a clinical context. Part II covers six clinical science subjects: General Diagnosis, Neuromusculoskeletal Diagnosis, Diagnostic Imaging, Principles of Chiropractic, Chiropractic Practice, and Associated Clinical Sciences 8. The diagnostic sections assess a candidate's ability to perform a patient history, conduct an examination, formulate a differential diagnosis, and interpret diagnostic imaging such as X-rays. The sections on Principles of Chiropractic and Chiropractic Practice evaluate knowledge specific to the profession's history, philosophy, and practical application of various adjustive techniques, a history documented in works such as David D. Palmer's Three generations: a history of chiropractic 15. Together, these two examinations serve as a comprehensive evaluation of the theoretical knowledge base required for competent practice, and passing them is a critical step before a candidate can proceed to the NBCE Part III written clinical competency examination 9 and the Part IV practical skills assessment.
National Board Examinations Part III and Physiotherapy: Clinical competency
After demonstrating foundational and clinical science knowledge in Parts I and II, candidates for chiropractic licensure must pass the National Board of Chiropractic Examiners (NBCE) Part III written examination. This examination serves as a critical checkpoint for clinical competency, assessing a candidate's ability to apply knowledge in a practical, diagnostic context. The test is structured around nine distinct clinical domains that simulate the workflow of patient management 9. Key domains evaluated include Case History, where candidates must demonstrate proficiency in gathering relevant patient information, recognizing patterns of symptoms, and identifying potential red flags for serious pathology. The Physical Examination domain tests the ability to perform and interpret standard physical assessment procedures.
Building upon this, the Neuromusculoskeletal Examination domain focuses on the specific skills central to chiropractic practice, such as orthopedic testing, neurological evaluation of reflexes and sensory-motor function, and postural and gait analysis 9. This aligns with the legal definition of chiropractic in New York, which centers on detecting and correcting structural imbalances and subluxations to remove nerve interference 1. The Diagnostic Imaging domain assesses the candidate's competence in interpreting radiographic findings, identifying contraindications for manual therapies, and recognizing biomechanical faults or pathologies visible on X-rays and other imaging modalities 9. A final key domain, Clinical Laboratory and Special Studies, requires candidates to demonstrate the ability to order appropriate tests, such as blood panels or urinalysis, and interpret the results to formulate a comprehensive differential diagnosis 9. Successful completion of Part III indicates that a candidate possesses the diagnostic acumen required for primary-contact patient care before proceeding to hands-on practical assessment.
Separate from the core four-part examination series, the NBCE also administers a stand-alone Physiotherapy (PT) examination, which is a requirement for licensure in New York 4. This written test assesses a candidate's knowledge of the theory and application of a wide range of adjunctive therapeutic modalities used to complement the chiropractic adjustment. The examination covers the principles, indications, and contraindications for various physical agents 10. These include thermal therapies such as cryotherapy and superficial heat, light therapies like low-level laser, and sound therapies, most notably therapeutic ultrasound 10. The test also evaluates knowledge of electrical therapies, including transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC), as well as mechanical therapies like spinal traction 10. Furthermore, the PT exam assesses competence in therapeutic exercise prescription, a critical component of patient rehabilitation and stabilization. The inclusion of these modalities in modern practice, and their formal assessment by the NBCE, reflects an evolution from the profession's early singular focus on manual adjustment, a history detailed in texts such as The secret history of chiropractic 17. The integration of these procedures with traditional adjustive methods is a core component of contemporary chiropractic technique, as outlined in manuals like F. P. DeGiacomo's Textbook of chiropractic technique.
National Board Examination Part IV: The practical skills assessment
The final examination required for licensure is the National Board of Chiropractic Examiners (NBCE) Part IV, a practical skills assessment that serves as the capstone to the board certification process. Unlike the preceding written examinations that assess foundational and clinical knowledge 7 8, Part IV evaluates a candidate's hands-on proficiency in a clinical setting. The examination utilizes an Objective Structured Clinical Examination (OSCE) format. This format consists of multiple timed stations, each designed to simulate a real-world clinical encounter or task. Standardized patients, who are actors trained to portray specific case scenarios, and trained chiropractic examiners, who score performance against a predetermined checklist, ensure a consistent and objective evaluation for all candidates. Successful completion of Part IV demonstrates to state licensing boards, including the New York State Education Department 4, that an applicant possesses the minimum practical competence required for safe and effective patient care.
The Part IV examination is structured around three core competency domains: diagnostic imaging, chiropractic technique, and case management. In the diagnostic imaging stations, candidates are required to interpret radiographs. This includes identifying normal and anomalous anatomy, recognizing signs of pathology, and assessing biomechanical factors such as spinal alignment and degenerative changes. This practical application builds upon the theoretical knowledge tested in the Diagnostic Imaging sections of the Part II and Part III written exams 9.
The chiropractic technique stations assess the candidate’s psychomotor skills in performing adjustments. Examiners evaluate the candidate's ability to properly position the patient, establish correct doctor-hand contacts, and deliver a simulated adjustive thrust for various spinal or extraspinal regions. The techniques tested reflect standard procedures taught in accredited chiropractic colleges and documented in manuals such as F. P. DeGiacomo's Textbook of chiropractic technique. This component directly evaluates a candidate’s ability to perform the central function of the profession, defined in New York as detecting and correcting structural imbalance by manual or mechanical means to remove nerve interference 1.
The case management stations are the most integrative part of the examination. Here, candidates interact with standardized patients to perform tasks that mirror a complete patient visit. These tasks may include taking a focused case history, conducting a relevant physical examination, and communicating a diagnosis and management plan. These stations test the application of clinical reasoning skills previously examined in written form in Part III, which covers domains such as Case History, Physical Examination, and Neuromusculoskeletal Examination 9. The examiner scores the candidate on their data collection, clinical decision-making, and interpersonal communication skills, providing a holistic assessment of their readiness for independent practice.
The New York State application and review process
After satisfying the educational and examination prerequisites, a candidate for chiropractic licensure in New York must navigate a multistep administrative process with the New York State Education Department (NYSED) Office of the Professions 4. The process is initiated by the submission of the "Application for Licensure and First Registration" (Form 1), a comprehensive document requiring the applicant to provide personal data, a record of all education, and a sworn statement regarding professional conduct. This form must be accompanied by the combined application and initial three-year registration fee, as specified by the NYSED. The entire process of state-level licensure, a critical step in professionalization, evolved over decades as disciplines like chiropractic sought to establish legitimacy and public trust, a historical arc detailed in works such as D. D. Palmer's foundational text, The Chiropractor 5.
A complete application file requires the submission of multiple documents directly from third-party institutions. The applicant's chiropractic college must submit a "Certification of Professional Education" (Form 2) directly to NYSED, verifying the applicant’s Doctor of Chiropractic degree and graduation date. Similarly, the National Board of Chiropractic Examiners (NBCE) must transmit an official transcript of the applicant's scores for all required examination parts directly to the Office of the Professions. NYSED will not accept transcripts or score reports submitted by the applicant. For applicants who are or have been licensed in another jurisdiction, a "Verification of Licensure and/or Examination" (Form 3) must be sent by each state or provincial licensing authority.
Beyond standard academic and examination credentials, New York mandates the completion of specific training courses from NYSED-approved providers. All applicants must complete coursework or training in the identification and reporting of child abuse and maltreatment, a requirement enforced to protect public welfare 16. Verification of this training must be submitted directly by the provider or by the applicant using a "Certificate of Completion" form. Under New York State Education Law § 6505-b, certain licensed healthcare professionals, including dentists, registered nurses, and optometrists, must complete coursework or training in infection control and barrier precautions every four years. 18. These state-specific requirements must be fulfilled before a license can be issued.
Once the Office of the Professions has received all required forms, fees, and verifications, the applicant's file is considered complete and is placed in queue for a final review. A licensure analyst at NYSED evaluates the entire packet to ensure every statutory and regulatory requirement has been met. This includes confirming educational qualifications, passing scores on all required NBCE exams, completion of mandated training, and a clear record of professional conduct. Upon successful review and approval of the application, NYSED issues the chiropractor a license number and a registration certificate, authorizing them to practice legally within the State of New York. The initial registration is valid for three years, after which the licensee must adhere to triennial renewal and continuing education requirements.
Licensure by endorsement and comparison with national standards
For chiropractors already licensed and practicing in another U.S. state or territory, New York offers a pathway to licensure by endorsement, which avoids the need to retake certain foundational examinations. This process is governed by the New York State Education Department (NYSED) and is intended for established practitioners with a clean professional record 4. To qualify for endorsement, an applicant must provide documentation of having been licensed in another jurisdiction for at least two years. Critically, the applicant must demonstrate that the educational, examination, and experience requirements they met for their initial license were substantially equivalent to those required by New York State at that time 16. This includes having completed a minimum of 90 semester hours of pre-professional college coursework prior to entering a Doctor of Chiropractic program 6.
A pivotal component of the endorsement application review is the verification of the applicant's professional conduct and disciplinary history. To accomplish this, the NYSED 13 consults the Chiropractic Information Network-Board Action Databank (CIN-BAD). Maintained by the Federation of Chiropractic Licensing Boards (FCLB), CIN-BAD is a national database that compiles public disciplinary actions taken against chiropractors by licensing boards across the country 12. A thorough review of this database is a standard procedure for all endorsement candidates to ensure they meet New York's character and fitness standards as outlined in Education Law, Article 132 3. Interstate compacts, which are formal, legally binding agreements enacted by state legislatures, have become a primary mechanism for enabling licensed professionals to practice across state lines, with over 400 pieces of such legislation enacted since 2015. 19.
When compared to national standards, New York's requirements for chiropractic licensure are among the more stringent. A primary point of distinction is its examination policy. New York mandates that all applicants, including those by endorsement who may not have taken all exams initially, must have passed all four parts of the National Board of Chiropractic Examiners (NBCE) examinations. These include Part I (foundational sciences), Part II (clinical sciences), and the Part III written clinical competency examination 7 8 9. Furthermore, New York requires a passing score on the NBCE's separate Physiotherapy (PT) examination, which assesses knowledge of modalities like thermal, light, sound, and electrical therapies 10. While the first three NBCE parts are a near-universal requirement for licensure in the United States, the mandatory inclusion of the PT exam is not uniform across all states; some jurisdictions consider physiotherapy an optional or advanced certification. Similarly, New York’s continuing education (CE) requirements are specific, mandating 36 hours every three-year registration period, with a notable stipulation that at least 12 of these hours must cover patient communications, record keeping, and legal or ethical matters 11. This prescribed focus on professional conduct and practice management differs from many other states that grant more latitude in CE topic selection.
Maintaining licensure: Continuing education and professional conduct
Obtaining a chiropractic license in New York marks the beginning, not the conclusion, of a practitioner's professional obligations. The New York State Education Department (NYSED) requires all licensed chiropractors to renew their registration on a triennial basis to maintain an active license in good standing 16. This renewal process is contingent upon the fulfillment of specific continuing education (CE) mandates and adherence to a strict code of professional conduct as defined by state law and regulations. These requirements ensure that practitioners remain current with advancements in the field and uphold the ethical standards necessary for public protection.
The cornerstone of licensure maintenance is the continuing education requirement. During each three-year registration period, a chiropractor must complete a minimum of 36 hours of approved CE 11. The NYSED stipulates a specific curriculum for a portion of this coursework. At least 12 of the 36 hours must be dedicated to topics directly related to practice management and ethics, including patient communications, proper record keeping, and matters of New York State law and ethics 11. The remaining 24 hours may be completed in other subject areas relevant to the scope of chiropractic, which in New York is defined as detecting and correcting structural imbalance and subluxations by manual or mechanical means 1. Acceptable subjects for these hours can include areas such as diagnostic imaging, neuromusculoskeletal diagnosis, and chiropractic technique, reflecting the clinical science domains tested in the NBCE examinations 8. All CE courses and providers must be formally approved by the New York State Education Department to qualify for credit 18.
Beyond educational requirements, licensees are perpetually subject to the rules of professional conduct established under the New York State Education Law, Article 132 3. The State Board for Chiropractic, operating under the NYSED Board of Regents, investigates all complaints of professional misconduct. Such misconduct can include a wide range of infractions, from fraudulent billing and advertising to negligence, incompetence, and practicing beyond the legal scope of the profession. The mandated CE in ethics and law 11 serves as a proactive measure to educate practitioners on these boundaries. If a chiropractor is found guilty of professional misconduct after a hearing, the Board of Regents may impose penalties that include censure and reprimand, fines, suspension of the license, or complete revocation.
Disciplinary actions taken in New York have consequences that can extend beyond the state's borders. Public actions are reported to the Chiropractic Information Network-Board Action Databank (CIN-BAD), a national repository managed by the Federation of Chiropractic Licensing Boards (FCLB) 12. Other state licensing boards consult this database when a chiropractor applies for licensure by endorsement, meaning a disciplinary mark in New York can impede a practitioner's ability to relocate and practice elsewhere 12. This system of ongoing education and professional oversight creates a regulatory framework that is far removed from the profession's more unregulated origins, as chronicled in historical works such as D. D. Palmer's The Chiropractor 5.
Sources
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The practice of chiropractic is defined as detecting and correcting structural imbalance, distortion, or subluxations in the human body by manual or mechanical means to remove nerve interference and its effects related to the vertebral column. - https://www.nysenate.gov/legislation/laws/EDN/6551
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Walter I. Wardwell, Chiropractic (1992) - https://openlibrary.org/works/OL4280776W
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New York State Education Law, Article 132 - https://www.nysenate.gov/legislation/laws/EDN/T8A132
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New York State Education Department - https://www.op.nysed.gov/professions/chiropractic/license-requirements#child
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Textbook of chiropractic technique by F. P. DeGiacomo (1981) - https://openlibrary.org/works/OL6099349W
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To be licensed as a chiropractor in New York, an applicant must have completed at least 90 semester hours of pre-professional college study. - https://www.op.nysed.gov/professions/chiropractic/license-requirements
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Part I of the NBCE examination assesses six foundational science subjects: General Anatomy, Spinal Anatomy, Physiology, Chemistry, Pathology, and Microbiology. - https://mynbce.org/part-i/
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Part II of the NBCE examination assesses six clinical science subjects: General Diagnosis, Neuromusculoskeletal Diagnosis, Diagnostic Imaging, Principles of Chiropractic, Chiropractic Practice, and Associated Clinical Sciences. - https://mynbce.org/part-ii/
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The NBCE Part III written clinical competency examination evaluates nine domains, including Case History, Physical Examination, Neuromusculoskeletal Examination, Diagnostic Imaging, and Clinical Laboratory and Special Studies. - https://mynbce.org/part-iii/
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The NBCE Physiotherapy (PT) examination assesses knowledge of thermal, light, sound, electrical, and mechanical therapies, as well as therapeutic exercise. - https://mynbce.org/physiotherapy/
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New York requires chiropractors to complete 36 hours of continuing education every three years, with at least 12 hours in patient communications, record keeping, and matters of law and/or ethics. - https://www.op.nysed.gov/professions/chiropractic/continuing-education
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The FCLB's Chiropractic Information Network-Board Action Databank (CIN-BAD) is a database of public disciplinary actions against chiropractors, which can be reviewed by licensing boards during endorsement applications. - https://www.fclb.org/cinbad/
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New York State Education Law § 6508, 2024 - https://www.nysenate.gov/legislation/laws/EDN/T8A130
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The official history of chiropractic in Texas by Walter R. Rhodes (1978) - https://openlibrary.org/works/OL6827451W
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Practice Analysis of Chiropractic, 2020 - https://www.nbce.org/practice-analysis-of-chiropractic-2020/
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New York State Senate, n.d. - https://www.nysenate.gov/legislation/laws/EDN/6505-B
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The Council of State Governments, 2024 - https://www.csg.org/2024/interstate-compacts-a-legislative-toolkit-for-the-states/