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Chiropractic Clinical Assistant Application and Exam Registration for Certificate of Competency

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  • Chiropractic Clinical Assistant Application and Exam Registration for Certificate of Competency
  • Application

    I hereby apply for certification as a Certified Chiropractic Clinical Assistant per N.C.G.S. 90-143.4, and along with this completed application/registration, and delivery to the Board office of the required documentation outlined below, I agree to pay the $35 application fee required by the NC State Board of Examiners.

    1. Upload a copy of your High School Diploma or High School Transcripts or GED or equivalent. (See below)
    2. Upload a copy of your Driver’s License or Birth Certificate.(See below)
    3. Attestation of Good Moral Character. This portion of the application form should be completed by a person who knows you but is not related to you, such as an employer, teacher, minister, neighbor, etc. You will provide an email address at the bottom of the application for the person you would like to complete the form on your behalf.(See below)
  • These documents can also be faxed to us at 704-793-1385 or emailed to john@ncchiroboard.com.

    Application Fee: $35.00 (NON-REFUNDABLE), payable by credit card on the application page of the Board Website: https://ncchiroboard.com/make-a-payment/new-applicants/ca/
  • I. Personal Information

  • II. Education

  • III. Personal History

  • IV. Employment History

  • Drop files here or
    Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 256 MB.
    • The receiver of the email should know you but not be related to you, such as an employer, teacher, minister, neighbor, etc.

    CONTACT INFO

    North Carolina State Board of Chiropractic Examiners
    9121 Anson Way, Ste 200
    Raleigh, NC 27615
    Email ncboce@ncchiroboard.com
    P  (704) 793-1342
    F  (704) 793-1385

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    Dr. Joe Siragusa, Executive Director
    dr.joe@ncchiroboard.com
    Extension: 1004


    Lisa Hicks-Jones, Investigator
    lisa@ncchiroboard.com
    Extension: 1002


    John Riggleman, Licensing Specialist
    john@ncchiroboard.com
    Extension: 1008


    Anna Harvey, Regulatory Assistant
    anna@ncchiroboard.com
    Extension: 1003

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