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Maryland Department of Health
State Board of Chiropractic Examiners
State Board of Chiropractic Examiners
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Chiropractic Applicants, Licensing and Registration
Chiropractors
Doctor of Chiropractic License Application
(Fillable PDF to Print Out or Print Out and Type/Print Legibly)
Unofficial Copies of Undergraduate Transcripts w/ Application
Unofficial Copies of Chiropractic College Transcripts w/Application
Request Official Transcripts to be sent Directly to this Board
Request Official NBCE Score Report to be sent Directly to this Board
Copy of Healthcare Provider Level CPR
Two Certificate(s) of Moral Character Forms to be completed by Licensed D.C. & sent by that D.C.
Criminal History Records Check - Fingerprinting Instructions
MD Fingerprinting Form - In State Only
Out of State Fingerprinting MUST contact Board of Fingerprint Card first
Fingerprint Receipt Must be enclosed with Application
Verification of Out of State Licensure to be sent Directly to this Board by Issuing Agency
MD Board Exam Schedule
PDF Fillable "Certificate of Moral Character Form"
to be completed and mailed by licensed D.C.
D.C. Application for Re-examination
Special Accommodations Request
(Requires medical/school documentation)
Criminal History Records Check Form and Instructions
Licensed Chiropractors
Application for Licensure by Credentials
Application for Licensure by Waiver For Visiting Chiropractor
Continuing Education Guidelines and Forms
Externship Application
(Recent Graduate and Out-of-State DC only)
Preceptorship Application
(Students only)
Preceptor Sponsor Application
Preceptor’s Final Evaluation
Supervising Chiropractor Application
Dry Needling Registration Application Form
Criminal History Records Check Form and Instructions
Chiropractic Assistant Applicants
CA Training Program
Stage 1
(4 Page Packet with all required documents must be submitted)
CA Training Program Guidelines AND CA Applicant/Trainee “Request to Employ” Packet
Application Packet includes:
Supervising D.C. (Pages 1 & 2 to complete)
CA Trainee (Pages 3 & 4 to complete)
Copy of Birth Cert.
Copy of D. L or valid State ID
Copy of Fingerprint Receipt
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
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
For Request to Hire Authorization (Prior to March 18, 2019)
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)
C.A Inactive Application Form
2021 Late Renewal / Late Inactive Status Application
Additional Forms
Inactive Status Application
Reinstatement and Reactivation Application
Complaint Form
Notification of Address Change
Notification of Name Change
Request for Duplicate License
Request for Replacement License
Request for License Verification
Roster Request
Special Accommodations Request
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