STARTER GUIDE · FOR CHIROPRACTIC STUDENTS AND NEW GRADS · Published October 27, 2026

Starting Your First Chiropractic Practice: A Step-by-Step Checklist for Students and New Grads

Reviewed by Dr. Ryan Goss, DC

How we built this guide: every rule and requirement below comes from the official source linked next to it (NBCE, SBA, IRS, CMS, FDA and ADA.gov), checked October 27, 2026. Requirements vary by state and change over time, so confirm with your state board and your own attorney and accountant. We do not list costs because they vary widely by state and market.

Step 1: Licensing basics

You can only practice in a state where you hold a license, and the license comes from that state's board, not from the NBCE. The NBCE writes and gives the exams; the state board reviews your transcripts, scores and other documents and then issues the license. Most states require passing scores on all or part of the NBCE's four-part exam. Source: NBCE, Certification and Licensure (checked Oct 27, 2026).

• Confirm which NBCE parts your state requires. Some states add their own exams: the NBCE lists state exams for Florida, Missouri, Oklahoma and Oregon. Source: NBCE exams.
• Plan for the final state steps. The NBCE says these typically include a criminal background check, a state-level exam on the state's scope of practice, and a list of personal references.
• Find your state board through the NBCE list of state licensing board links or the FCLB directory of chiropractic regulatory boards. Read the board's rules on scope of practice, advertising and record keeping before you open.
• Plan for continuing education. The NBCE notes that every state but one requires chiropractors to earn continuing education credits each year to keep a license.

Step 2: Entity, tax ID and bank account

The SBA says your business structure affects your taxes, your ability to raise money, the paperwork you file and your personal liability, and that you need to choose it before you register with the state. It recommends talking with business counselors, attorneys and accountants. Source: SBA, Launch your business (checked Oct 27, 2026).

• Pick a structure with an attorney and an accountant. Ask whether your state has special rules for health care professionals forming an entity.
• Register with your state (usually the Secretary of State). The SBA notes that LLCs, corporations and partnerships need a registered agent in the state before they file, and that you might need to register a DBA (trade name) with your state, county or city.
• Get your EIN from the IRS. The IRS says the online application is free and you never have to pay a fee for an EIN. If you are forming a corporation or LLC, form it with your state first, or your EIN application may be delayed. Source: IRS, Get an EIN. The same IRS page links to FinCEN so you can check whether beneficial ownership reporting applies to your company.
• Open a business bank account. The SBA says you can open one once you have your EIN, and that banks commonly ask for the EIN, your formation documents, ownership agreements and a business license.
• Write a business plan and line up funding. See the SBA business plan guide and SBA loan programs. Lenders set their own terms; get them in writing.

Step 3: NPI and insurance enrollment

• Get your NPI. CMS says the fastest way is the online application in NPPES. CMS's NPI fact sheet explains that a Type 1 NPI is for individual providers and a Type 2 NPI is for organizations such as physician groups, and that an incorporated provider can get a Type 1 NPI for themselves and a Type 2 NPI for the corporation or LLC. Having an NPI does not mean you are licensed or credentialed, does not enroll you in a health plan and does not replace Medicare enrollment. Sources: CMS, How to apply; CMS NPI fact sheet (PDF); NPPES; NPI Registry.
• Decide which payers you will accept. Medicare enrollment is done through PECOS, CMS's online enrollment system. Source: CMS, Medicare enrollment for providers. For commercial plans, ask each insurer about its credentialing process.
• Or plan a cash-based model. If you won't bill insurance, decide this before you choose software, since it changes what you need from billing tools.

Step 4: Location and lease

The SBA says your location determines the taxes, zoning laws and regulations you are subject to, and that if you buy, rent or build, you should make sure the property conforms to local zoning requirements. Source: SBA, Pick your business location.

• Start-up or purchase? Buying an existing practice can give you an established patient base. The SBA's location guide also covers buying an existing business.
• Have an attorney review the lease before you sign: term, renewal options, build-out allowance, signage rights and who pays for repairs.
• Plan for accessibility. The ADA lists doctors' offices among the businesses that serve the public under Title III. Source: ADA.gov, Title III.
• Plan the space: treatment rooms, X-ray room if you will have one, front desk, and exterior signage (check local sign rules and your lease).

Step 5: Equipment: tables and X-ray

• Tables first. Match the table to the techniques you use (drop, flexion-distraction, hi-lo, portable), then compare warranty, lead time and delivery. See our adjusting tables guide.
• Consider used or refurbished equipment to stretch your start-up budget. Ask about warranty and return terms.
• X-ray: check your state's rules before you buy. The FDA regulates X-ray equipment makers; the use of X-ray equipment is regulated by the states. FDA notes that CRCPD keeps contact information for each state's radiation control agency. Sources: FDA, Medical X-ray Imaging; FDA, Radiation-emitting products FAQ.
• Decide who reads your films and how images are stored and shared with your EHR. See our digital X-ray guide.

Step 6: EHR, billing and patient scheduling

• Choose your EHR early. It runs your notes, scheduling, intake and often billing, so switching later is painful. Ask about total monthly cost per provider, setup and data-migration fees, contract length and data export.
• Confirm the vendor signs a BAA if it will store patient records. See BAAs explained.
• Set up online scheduling so new patients can request scheduled appointments from your website and Google Business Profile, with automatic reminders.
• Cover the phone. Decide who answers when you are with a patient: front desk, an answering service or an AI receptionist.
• Billing: decide whether you will bill in-house, through your EHR's billing service or with an outside billing company, and how you will take patient payments.

Related guides: Best EMR/EHR for chiropractors · ChiroTouch alternatives with published prices · Scheduling and online intake software.

Step 7: Insurance and malpractice

The SBA describes professional liability insurance as coverage for financial loss from malpractice, errors and negligence, and lists general liability, commercial property and a business owner's policy as other common types. It also says businesses with employees must carry workers' compensation, unemployment and disability insurance, and that some states require more. Source: SBA, Get business insurance.

• Get malpractice quotes before you sign a lease or job offer. Ask about claims-made vs occurrence coverage and what happens to your coverage if you change jobs.
• Ask your state board and landlord whether they require a minimum coverage amount.
• Review coverage every year as you add staff, equipment and services.

Step 8: Hiring your first team member

• Know your employer tax duties. The IRS explains the federal employment taxes employers must withhold and pay. Source: IRS, Understanding employment taxes.
• Set up payroll before your first hire, along with workers' compensation and any state registrations.
• Write a simple front-desk playbook: greeting, phone script, scheduling rules and how to handle new-patient calls.

Step 9: Website and marketing

• Register your domain in the practice's name. The SBA notes that once you register a domain, no one else can use it while you keep renewing it.
• Claim your Google Business Profile and use the exact same name, address and phone everywhere.
• Build a simple website with a New Patients page, one page per service, your location and hours, and a schedule button on every page. See How to build a chiropractic website with AI.
• Start asking for reviews from your first patients, and follow your state board's advertising rules. See Local SEO for chiropractors.
• Make it easy for AI assistants to find you. See How to get your clinic found in AI search.

Step 10: Opening-week patient scheduling

• Test the whole path as if you were a new patient: search, website, schedule, reminder, intake forms, check-in, payment.
• Set reminder and follow-up messages so patients keep their scheduled appointments and come back when their care plan calls for it.
• Track where new patients come from (Google, referral, website, signage) from day one.

FAQ

Does the NBCE issue my chiropractic license?

No. The NBCE is a testing organization. Your state licensing board reviews your exam scores, transcripts and other documents and issues the license.

Does an NPI mean I am licensed or credentialed?

No. CMS's NPI fact sheet says having an NPI does not ensure a provider is licensed or credentialed, does not enroll a provider in a health plan and does not guarantee payment.

Do I have to pay for an EIN?

No. The IRS says you never have to pay a fee for an EIN and warns to beware of websites that charge for one.

Who regulates the X-ray machine in a chiropractic office?

The FDA regulates the companies that make X-ray equipment. The use of the equipment is regulated by the states, so check with your state's radiation control agency before you buy or install a unit.

Should I start a practice or buy one?

It depends on your market, finances and goals. Buying can give you an established patient base. Talk with an attorney, an accountant and a practice transition advisor before deciding.

Not legal, tax or insurance advice. Check your state board's rules before you open.