21 NCAC 10 .0202             APPLICATION FOR LICENSURE

(a)  General. Application for licensure to practice chiropractic pursuant to G.S. 90-143 shall be made in writing upon forms provide by the Board. Application forms and instructions may be found on the Board's website, www.ncchiroboard.com. Applications not completed within 12 months following submission to the Board shall be denied. Applications shall contain the following:

(1)           the applicant's name, residential address, phone number, email address, and date of birth;

(2)           the social security number of the applicant;

(3)           the applicant's educational history and degree attainment;

(4)           character reference statements on forms prescribed by the Board of three persons not related to the applicant, two of which must be submitted by Board-licensed chiropractic physicians in good standing with the Board;

(5)           the applicant's employment history;

(6)           whether the applicant now has or has ever had an addiction to, or dependency on, alcohol or other controlled substances and, if so, an explanation of the same;

(7)           whether the applicant has ever been under clinical treatment for addiction to, or dependency on, alcohol or other controlled substances and, if so, an explanation of the same;

(8)           whether the applicant has any physical, mental, or emotional infirmities that impair his or her ability to practice chiropractic safely and, if so, an explanation of the same;

(9)           whether the applicant has ever been certified, licensed, or registered to practice chiropractic by the Board, by another occupational Board, or in another state or jurisdiction and, if so:

(A)          whether the credential is in good standing;

(B)          in what state or jurisdiction was the credential issued; and

(C)          the issuance date and expiration date of the credential.

(10)         whether the applicant has ever had a chiropractic credential denied, limited, reprimanded, suspended, or revoked and, if so, an explanation of the same;

(11)         whether the applicant has ever been convicted of a felony or misdemeanor and, if so, the nature, date, and jurisdiction of the conviction;

(12)         whether any criminal charges or criminal investigations, if known, are pending against the applicant and if so, the details of said charges or investigations;

(13)         whether any court, board, agency, or professional organization regulating chiropractic has disciplined the applicant and, if so, an explanation of the same;

(14)         whether any disciplinary charges are pending against the applicant before any court, board, agency, or professional organization regulating chiropractic and, if so, an explanation of the same;

(15)         whether the applicant has ever voluntarily given up any licensure privileges in order to avoid disciplinary sanctions;

(16)         whether the applicant has ever been sanctioned or suspended from participation in Medicare or Medicaid and, if so, an explanation of the same;

(17)         whether the applicant has ever been denied membership in a professional association or, if admitted, ever been suspended or had membership not renewed due to a breach of ethics and, if so, an explanation of the same;

(18)         whether the applicant has had a malpractice judgment entered against him or her and, if so, an explanation for the same;

(19)         whether the applicant is certified by the Board or the National Board of Chiropractic Examiners to practice Acupuncture, as defined in Rule .0208 of this Section;

(20)         A copy of the applicant's government-issued identification document, such as a driver's license or passport;

(21)         A certified self-query response from the National Practitioner Data Bank ("NPDB") sent directly to the Board regarding the applicant's record with NPDB;

(22)         the applicant's affirmation that:

(A)          the applicant has read and will comply with Article 8 of Chapter 90 of the North Carolina General Statutes and the administrative rules promulgated by the Board;

(B)          the information provided by the applicant in the application is true;

(C)          the applicant consents to a criminal history record check as required by G.S. 90‑143.3; and

(D)          the applicant has read and understands the public notice statement on employee misclassification that is set forth in the application and has disclosed any investigations for employee misclassification, and its results, over the preceding 12-month period, as prescribed by G.S. 143-789; and

(23)         the application fee, as prescribed in Paragraph (c) of this Rule.

(b)  Deadlines for Filing Applications. Applications shall be received at the Board office no later than 15 days before the date on which the applicant wishes to sit for examination, as provided in Rule .0203(b) of this Section.

(c)  Application Fee. A non-refundable application fee of three hundred dollars ($300.00) shall accompany each application. This fee shall be paid by credit card through the Board's website, www.ncchiroboard.com.

History Note:        Authority G.S. 90-142; 90-143; 90-143.1; 90-143.3; 90-145; 90-146; 90-149;

Eff. February 1, 1976;

Readopted Eff. January 27, 1978;

Amended Eff. October 17, 1980;

Legislative Objection Lodged Eff. December 17, 1982;

Curative Amendment Eff. December 30, 1982;

Amended Eff. January 1, 1983;

Legislative Objection Lodged Eff. January 31, 1983;

Curative Amendment Eff. February 28, 1983;

Amended Eff. January 1, 1989;

Temporary Amendment Eff. January 1, 2003;

Temporary Amendment Expired October 31, 2003;

Amended Eff. April 1, 2018; August 1, 2004; February 1, 2004;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. April 27, 2019;

Readopted Eff. April 1, 2026.