Opening a Chiropractic Practice in a New State

Opening a chiropractic practice in a new state works best in this order: get your chiropractic license in that state first, then set up an entity the state allows to own a chiropractic practice and employ you, then handle the local registrations (practice entity, location, x-ray equipment and assistant credentials), confirm malpractice coverage meets the state's minimum, and only then start payer enrollment, which depends on the license. The license is the long pole and the one step nobody can speed up with certainty, so it goes first, before the lease.

Below is the licensing and registration side. Entity structure, tax and lease terms belong with your lawyer and accountant.

Step 1: Which license route do I use?

If you are licensed elsewhere, check the state's endorsement route; if you do not qualify, the exam route. The terms differ more than most DCs expect. Florida's MOBILE Act endorsement (section 456.0145, Florida Statutes) wants 2 of the last 4 years of practice and no discipline in 5 years; Texas wants the three years immediately before applying, no discipline ever and its jurisprudence exam (Tex. Occ. Code § 201.309); California reciprocates only with states that reciprocate with it, after five years (16 CCR § 323). Compare them in endorsement or the exam route, and see the state page for your target state.

Add any scope certification you need on day one to the same timeline. Florida's dry needling certification, for example, is issued only to Florida licensees after in-person coursework, an exam and 10 supervised sessions; see Florida's dry needling certification.

Step 2: Who can own the practice?

Some states limit who may employ a chiropractor. Florida's section 460.4167 says a person may not employ a Florida-licensed chiropractic physician, or engage one as a contractor, unless the person fits a listed category, such as an entity wholly owned by Florida-licensed chiropractic or medical physicians, a hospital-owned entity, a publicly traded corporation's entity or certain clinics with an MD or DO medical director. It also bars non-DCs from controlling a DC's clinical judgment on medical necessity, and requires equipment leases from non-DCs to leave the DC in complete control of the equipment or practice. If a non-chiropractor partner, investor or management company is involved, have counsel check the structure against the state's rules before you form the entity.

Step 3: Does the entity or location need registering?

Often, and with different offices:

• Chiropractic corporations. California requires a professional corporation rendering chiropractic services to hold a Certificate of Registration from the Board of Chiropractic Examiners, applied for on the board's form signed by an officer who is a licensee, with a $100 nonrefundable fee (16 CCR §§ 367.1 to 367.10).
• County recording. Alabama requires a DC's license to be recorded with the probate judge in the county where the DC practices, with proof sent to the board.
• Practice locations. Texas requires each licensee to keep the board informed of the primary practice location on request, keep records of secondary locations for six years, display the license and the board's notice to the public at every location, and report address changes within 30 days (22 Tex. Admin. Code §§ 75.2, 75.6, 75.7, 72.13).
• Ordinary business registrations such as the state's entity filing, any local business license and tax accounts, which are outside the board entirely.

Step 4: What about the x-ray room?

The machine is usually registered with the state radiation control program, not the chiropractic board. In Texas, no person may use radiation machines except as authorized in a certificate of registration from the Department of State Health Services (25 Tex. Admin. Code § 289.226). Plan shielding and registration before installation, and check who on staff may take films; Florida, for example, requires a radiologic technology certificate such as basic X-ray machine operator for non-licensed staff (section 468.302). See x-ray rules when you move states.

Step 5: What do my assistants need?

It depends on the state. Arizona requires notice to the board within seven days of hiring a chiropractic assistant and registration for each workplace and supervising DC; New Jersey licenses chiropractic assistants; Alaska requires clinical assistants to hold a recognized certification within 12 months of hire; New Mexico requires three months of supervised training with the DC physically present during treatment. Hire with those rules in mind. See which states regulate chiropractic assistants.

Step 6: Is my malpractice coverage enough?

Check the state minimum and whether your policy covers the new state. Florida requires $100,000 per claim and $300,000 aggregate or an approved alternative as a condition of licensure and renewal; Pennsylvania the same, with automatic suspension 60 days after coverage ends; Kansas $500,000 and $1.5 million. See malpractice coverage when you license in another state.

Step 7: When do I start payer enrollment?

As soon as the license issues. Payers verify the license, so enrollment cannot finish before it exists, but you can prepare the rest of the file while the application is pending. Medicare's rules make adding or changing a practice location a 30-day reportable event for enrolled practitioners (42 C.F.R. § 424.516(d)). White Glove Credentialing's guide to credentialing a new practice covers that side; see also after the license.

And the practice I am leaving?

If you are closing a practice elsewhere, the old state's rules still apply. Texas's rule on closing a practice lists steps to avoid patient abandonment: arrange records custody, tell active patients, post a sign, update public listings including social media, refund unused prepaid treatment and notify the board in writing (22 Tex. Admin. Code § 75.9). Decide whether to keep the old license active, move it to inactive status or let it go, before its renewal date; see keeping several licenses current.

A timeline that works

1. Months before: readiness review, license application, scope coursework.
2. While the license is pending: entity formation with counsel, location search, malpractice quote, x-ray plan, staffing plan, enrollment paperwork prepared.
3. License issued: sign the lease if you had not, register the entity and location where required, register the x-ray machine, file assistant credentials, start payer enrollment.
4. Before the first patient: displays and notices posted, coverage bound, records system ready.

Our Chiropractic Licensure Readiness Review ($149 one-time) sets the license plan; License by Endorsement ($499 per state) or the Full State License Application ($749 per state) files it; Scope Add-On Registration ($249) and Chiropractic Assistant Registration ($99 per assistant) cover the rest of the board filings. Board fees are extra, and the board decides.