UPDATED 2021

The Chiropractor Test Guide

The Chiropractor Test Summary
What: The National Board of Chiropractic Examiners test establish, maintain, and qualify a person as a professional in chiropractics and/or physiotherapy and acupuncture.
Who: The tests are administered and created by the National Board of Chiropractic Examiners (NBCE).
Where: The tests are taken at various chiropractic colleges in the United States and some are also offered in Canada, England, Australia and France.
When: Each test is offered at various times of the year, but most are only offered twice a year.
How: The exam is timed.
Type: The tests are taken as multiple choice and practical.
Why: Chiropractic licenses and post-licensure test are required to begin or continue practicing chiropractics.
Time: The exam has a set time limit set by the administrator.
Language: English
Preparation: Many preparation guides are available.
Cost: The tests range from $425 to $1125.

By Emily Irwin, Tests.com Contributing Writer

The National Board of Chiropractic Examiners (NBCE) is an organization which, among other responsibilities, creates and maintains different chiropractic licensing exams, including the written examination, part IV examination and post-licensure examination.

Written Examination
The written examination includes three parts plus two optional exams: the acupuncture exam and the physiotherapy exam. According to NBCE, Part I of the exam is centered on six scientific subjects:

  • General anatomy
  • Physiology
  • Chemistry
  • Pathology
  • Spinal anatomy
  • Public health
  • Microbiology


On the test, there are 110 questions for each subject, and test takers are given 90 minutes for each section. Part II is a similar format, with testing in the areas of:

  • General diagnosis
  • Diagnostic imaging
    principles of chiropractic
  • Neuromusculoskeletal diagnosis
  • Associated clinical sciences
  • Chiropractic practice


The Chiropractic practice section contains 100 questions, whereas every other section is made up of 110 questions and test takers are again given 90 questions for each section.

Part III tests nine different clinical areas:

  • Case history
  • Physical examination
  • Clinical laboratory and special studies examination
  • Neuromusculoskeletal examination
  • Roentgen logic examination
  • Diagnosis or clinical impression
  • Chiropractic techniques
  • Supportive techniques
  • Case management


Part III contains two sections of 100 questions each, allowing 120 minutes for each section. A score of 375 is considered passing on the written examination.

The exam is administered twice a year, in September and March. An application can be found online at nbce.org/written/application.html, and applicants can apply for the exam online or through the mail.

The fee for each part of the test is $475, as well as $200 for the physiotherapy test and $425 for the acupuncture test. Testing sites are located at different chiropractic colleges and applicants should note their preferred location on the application.

Part IV Examination
Most states in the US currently require that chiropractors complete the Part IV Examination. This exam tests diagnostic imaging, chiropractic technique and case management and is in the form of a practical with multiple stations for each section.

During diagnostic imaging, there are 10 stations with four minutes allowed at each station. The test taker is required to answer a group of multiple choice questions about each station.

In chiropractic technique there are five stations with five minutes for each station. The applicant will be evaluated by a licensed chiropractor for this part of the test.

Finally, for the case management portion, there are 20 stations which require the test taker to answer questions about a clinical case. He or she will be judged on how he or she treats the patient. Each station is given five minutes.

The exam is offered twice a year, in May and November, and the application can be found at nbce.org/OnlineApp/PartIV/closed.html. The fee is $1125, with a $20 fee for a transcript of the test score.

Post-Licensure Examination
There are two post-licensure tests available through the NBCE: the Special Purposes Examination for Chiropractic (SPEC) and the Ethics and Boundaries Examination (E&B). The SPEC looks at the chiropractor’s clinical competency and is often used as a form of discipline or if his or her license has been revoked. The test is offered six times a year in February, April, June, August, October and December, and can be taken at a computer test site. According to the NBCE, the exam assesses the following areas: patient interview

  • Physical examination
  • Neuromusculoskeletal examination
  • X-ray examination
  • Clinical lab and special studies
  • Diagnosis or clinical impression
  • Chiropractic techniques
  • Supportive techniques
  • Case intervention strategies


The E&B is similar to the SPEC in that it is only given at the request of a state licensing board. It is also offered six times a year during the same months as the SPEC at 200 test sites in the U.S. The E&B is made up of 100 questions in the areas of sexual harassment, sexual misconduct, unprofessional and unethical conduct and doctor’s duties and office procedures.

In order to take either test, according to the NBCE, applicants must be a licensed chiropractor, have a written request to take the tests and complete the applications, including any fees associated with the tests. The cost of each exam is $850 and a passing score is 375 or above.

Interested in becoming certified as a chiropractor? Take a look at our Directory of Chiropractic Tests.