Chiropractic 2025:

The 50 States of Chiropractic
Chiropractic 2025: Divergent Futures
Chiropractic faces a variety of different challenges and regulations in every state. Chiropractors cannot perform
acupuncture in many states, including Georgia (where DCs also cannot use vitamins), 41 Kentucky, 42 and Minnesota. 43
Kansas does not prohibit DCs from performing acupuncture, but it does prohibit DCs from referring to themselves
as “chiropractic physicians.” 44 There are different regulations regarding the drawing of blood as well. DCs cannot
draw blood (by needle syringe) in Arizona, 45 but they can do so in Iowa. 46 Iowa also allows DCs to give nutritional
advice, but not to “profit from the sale of nutritional products coinciding with the nutritional advice rendered.” 47
Colonic irrigation is generally not considered to be within the scope of practice for DCs, 48 and generally DCs cannot
use X-rays except for in analysis or diagnosis. 49 Minnesota does not allow DCs to use any device that utilizes sound
or heat to treat a condition unless the device was approved by the Federal Communications Commission (FCC),
and does not allow devices to be used above the patient’s neck. 50 In some cases, chiropractors can gain licenses with
expanded scope. For example, in Maryland, chiropractors can get an expanded license that includes the right to
practice physical therapy. 51
In addition to serving under widely varying regulations, chiropractors are not evenly distributed throughout the
United States. According to data from the Federation of Chiropractic Licensing Boards, fewer than 1,000 active
chiropractic licenses were registered for the U.S. Virgin Islands, the District of Columbia, Puerto Rico, and 24 states
in 2011. 52 Eight states had between 1,000 and 2,000 active licenses registered, ten states had 2,000-3,000 active
licenses registered, Georgia and New Jersey had over 3,000 active licenses registered, Illinois and Pennsylvania
had over 4,000 active licenses registered, while Texas, Florida, and New York had at least 5,000 active licenses
registered. California had over 13,000 active licenses registered.
Further adding to the diversity of the chiropractic experience, each state has different plans to cover certain essential
health benefits (EHBs), in relation to the Patient Protection and Affordable Care Act (PPACA). These EHB plans do
not always include chiropractic coverage, but when chiropractic coverage is included the plans do not cover them
in the same manner. Proposed EHB Benchmark Plans may cover chiropractic up to a certain annual monetary limit
per patient, up to a certain number of annual visits per patient, may cover chiropractic entirely, or may not cover
chiropractic at all.
Only four states (Alabama, Idaho, Illinois, and Montana) have plans that propose to cover chiropractic with annual
monetary limits per patient. These plans propose to cover chiropractic care with per patient annual limits of $600
(Alabama and Montana), $800 (Idaho), and $1,000 (this plan from Illinois, where chiropractors’ scope of practice is
as broad as medical doctors—minus surgery and pharmaceutical prescribing rights—only covers manipulation).
Twenty-eight states have plans that propose to cover chiropractic care with limitations on annual visits per person.
The EHB plan for the state of Washington covers the fewest annual visits, at 10 visits per person. Eight proposed
state plans cover 12 annual per person visits, another eight state plans cover 20 annual per person visits. Maine’s
plan is the most generous, covering 40 annual visits per person.
Thirteen states have plans that propose to cover chiropractic care without quantitative limits on service. These
include Iowa, Kansas, Louisiana, Maryland, Minnesota, New Hampshire, New Jersey, New Mexico, New York,
South Carolina, South Dakota, West Virginia, and Wisconsin. In contrast, proposed plans for five states (California,
Colorado, Hawaii, Oregon, and Utah) and the District of Columbia do not cover chiropractic care.
50