About the NBCE
The following are some of the most frequently asked questions about the NBCE and its examinations.
Pre-licensure examinations:
Post-licensure examinations:
Transcripts
- How do I request a transcript for the written examinations?
- How do I request a transcript for the Part IV Examination?
Examination schedules
Diplomate status
NBCE Written Examinations
How long does it take to grade the examinations?
To ensure that scores released to examinees are accurate, the National Board conducts numerous post-examination procedures. These include:
- Accounting for all answer sheets, which may include verifying that the bubbled-in examinee number is completed
- Carefully reading all comments made by examinees
- Researching certain questions based on the comments made
- Processing scores, including answer and scanning verification
- Comparing answer sheets to ensure that the computer scores match the hand-graded scores
- Proofing and posting scores to an individual’s permanent record
- Printing and releasing scores
This provides the examinee a very fair process. The process takes time, but examinees can be assured that it is the most accurate and fair process possible. Scores are posted online approximately six weeks after the examination. Written notification of scores are released to examinees approximately seven weeks after the examination. A list of dates for specific examination administrations, is available here.
What does the NBCE do with examinee comments regarding test questions or the administration of the exams?
All examinee comments are reviewed by NBCE staff. Subject specialists review comments regarding examination content and appropriate changes are made if warranted. Examination administration comments are researched and forwarded to college and test administration personnel as necessary.
How is passing or failing of examinations determined?
The NBCE-recommended passing score is 375 and anyone who receives a score below 375 fails. A passing score of 375 is carefully maintained through a process known as equating. Equating means that the difficulty of the examination is consistent from one test administration to the next. State boards may require a different score, so it is important to check with the state in which the examinee is requesting licensure for its requirements.
How many times can an individual take the examinations?
While still enrolled as a student, an applicant may take Part IV as often as necessary, provided approval has been given by the dean or registrar.
After graduation: There are NO current NBCE limitations.
Please be aware that some states impose a limit on the number of times an individual may take National Board exams.
How do I study for the NBCE examinations?
There are two aids provided by the NBCE: online sample tests and a list of reference texts.
What does the NBCE think about review courses?
A course emphasizing a review of concepts and principles may have value; however, the National Board believes that review courses that rely on rote memorization are of minimal value due to the high percentage of new material which appears on the examinations. In addition, the NBCE now offers sample exams online at www.nbce.org. Further, a list of recommended reference texts is located in the information brochure. The NBCE is not associated with any review course nor do we recommend any courses offered.
The NBCE would like all examinees to be aware that all NBCE examinations are copyrighted. Reproduction of NBCE test questions violates copyright law and may result in prosecution.
Do NBCE examinations contain predominantly old or new material?
The majority of NBCE examination questions are new.
Is it true that during the scoring process, NBCE will eliminate questions from the examination so that more people will fail?
This is NOT true. Occasionally, in post-examination review, if it is determined there is a flaw in a question, credit may be given for more than one choice. However, no credit is given if more than one answer is marked on an individual answer sheet. Questions are not eliminated.
Can an examinee review his or her tests after they have been scored?
Due to examination security, the examinations themselves may NOT be reviewed by the examinee.
NBCE Part IV Examination
What is the Part IV Examination?
Part IV is a practical examination developed by the NBCE, the results of which state licensing authorities may use for licensure purposes. The Part IV test plan consists of three major areas including Diagnostic Imaging, Chiropractic Technique, and Case Management. Like all NBCE examinations, Part IV adheres to accepted testing and measurement industry guidelines. To learn more about the Part IV Examination, read the NBCE Examinee Information brochure.
Why was Part IV produced by the NBCE?
Part IV resulted from a request by the Federation of Chiropractic Licensing Boards (FCLB) to develop a national standardized practical examination for chiropractic licensure.
How do I apply for Part IV?
Applicants may apply for Part IV online through the NBCE Web site at www.nbce.org. Applications are also available at college registrars' offices. Complete and submit the application, along with required fees and any documentation, to the NBCE by the published postmark deadline.
How do potential examinees know if the state in which they plan to practice accepts or requires Part IV?
For the most current information on state regulations pertaining to Part IV, potential examinees should contact the licensing board of the state in which they intend to practice. Links to licensing agencies are available from this Web site.
Who is eligible to take Part IV?
- Students enrolled in chiropractic colleges whose students are eligible to take the NBCE examinations may apply for the Part IV Examination if they have passed all of the NBCE Part I Examination by the Part IV application deadline and are within six months of graduation at the time of the Part IV Examination administration. Student applicants must obtain signatures of approval from their authorized college representative. The NBCE will not issue official transcripts to students until they have successfully completed Parts I, II, III and IV.
- Chiropractic college graduates taking Part IV for the first time must have completed all of the NBCE Part I Examination. Graduates may establish their eligibility by submitting a copy of their doctor of chiropractic degree or by obtaining approval signatures from their authorized college representatives.
- A doctor of chiropractic who has passed all of the NBCE Part I Examination is eligible to take the Part IV Examination. A doctor of chiropractic who has not passed Part I, and who holds a valid license to practice chiropractic issued on or before December 31, 1997, is eligible to take Part IV upon submission of a properly completed application, and a letter bearing the state seal from an authorized representative of a state board that has licensed the applicant. The letter must verify that the applicant is licensed by that agency, that the applicant’s license is not currently under suspension, and that there is no known disciplinary action in effect or pending. The letter should also reference that it is being completed as a Part IV requirement. Examinees should enclose the letter with their applications.
What portion of the Part IV examination is based on radiographs and other special imaging?
The Diagnostic Imaging portion of the examination uses plain-film radiolgraphs and special imaging, such as MRI and CT scans. There are also 10 stations in the Case Management section that include x-rays. Overall, approximately one-third of the Part IV examination relies on imaging.
Where does the NBCE obtain the radiographs and special imaging for the examination?
The NBCE obtains most of its radiographs and special imaging from chiropractic college clinics or private chiropractic radiology clinics. Once a year, the National Board convenes Part IV test committee meetings whose members include state board examiners and chiropractic consultants. Item writers also bring radiographs that are used in developing new questions.
How is the Part IV examination scored?
During the Diagnostic Imaging portion of the Part IV examination, examinees use scannable answer sheets to record answers relevant to the data provided. During the Chiropractic Technique portion of the examination, examinees must demonstrate particular adjustment set-ups consistent with written instructions. During the Case Management portion, trained "patients" simulate conditions commonly encountered in chiropractic practice. Examinees must demonstrate procedures in accordance with particular symptoms or specific conditions described. Trained examiners (licensed chiropractors) assess the practical portions of the examination.
Why does it take seven weeks to receive my scores in the mail?
Before scores are released, the NBCE carefully analyzes the statistical performance of every question and reviews examinees' written concerns about test questions. Test questions are carefully reconsidered by a review panel and final scores are determined. To be sure all exams are scored accurately, the NBCE conducts thorough manual checking of answer sheets with additional reviews of answer sheets of those who scored below passing. Only after all of these reviews are complete are score letters mailed to examinees. An unofficial score report is available online approximately six weeks are the examination. Scores are mailed to state boards approximately eight weeks are the examination.
If I pass the Part IV Examination, am I automatically licensed?
No! The NBCE is not a licensing authority. Examination applicants are responsible for contacting licensing authorities of states in which they are interested in practicing. Some state licensing authorities may have additional requirements for licensure, and examinees are advised to contact any state(s) of interest for specific requirements.
Why does the Part IV Examination cost more than other NBCE examinations?
Part IV is a labor intensive examination. It takes approximately 1,200 support personnel to administer the examination, a ratio of about two support personnel to every three examinees. Throughout the year the NBCE must coordinate the activities of key personnel, train auxiliary staff, and manage the roles and responsibilities of those involved at each test site in order to have a successful administration of the Part IV Examination.
What does a score of 375 mean?
An NBCE score of 375 means that an individual has passed the overall examination at 75%.
What are the benefits of Part IV?
Today, passage of Part IV enables an individual to become eligible for licensure in a majority of states without taking another practical examination. The number of states that accept or require results of the Part IV examination continues to increase. Examinees may take Part IV on many chiropractic college campuses within six months prior to graduation. An additional benefit is that a doctor of chiropractic does not have to maintain multiple state licenses. The Part IV examination meets requirements of nationally standardized examinations.
How do I request a transcript, and how much does it cost?
To request a transcript, complete the transcript request form in the NBCE Examinee Information brochure for Part IV or download the form from this Web site. Mail it along with any applicable fees to NBCE. The first transcript is free; each additional transcript is $25 per state. Allow at least two weeks processing time for transcript requests.
Special Purposes Examination for Chiropractic
What is SPEC?
The Special Purposes Examination for Chiropractic (SPEC) is an examination for re-assessing clinical competency and licensing eligibility in cases involving disciplinary action, reciprocity, and other state board needs. It demonstrates proficiency in conditions generally encountered in chiropractic practice.
Facilitating unprecedented geographic mobility, SPEC is often used for state-to-state reciprocity. Since its introduction in 1998, more than 70 percent of SPEC examinees have taken the examination to obtain state licensure reciprocity.
The SPEC test plan is based on practice requirements obtained from the NBCE’s chiropractic practice analysis survey. The material presented in SPEC requires that examinees demonstrate the appropriate clinical understanding and judgments required in general chiropractic practice.
SPEC is designed to assess individuals who hold or have held a license to practice chiropractic.
When should SPEC be used?
State licensing agencies have discretion over the use of SPEC scores in their jurisdictions. The SPEC examination is administered only at the request or requirement of a state board. Circumstances in which these exams might be used include (but are not limited to):
- Disciplinary action, including the assessment of clinical competency issues.
- Suspension, revocation or licensure relapse (depending on the requirement of the state board).
- State-to-State reciprocity/endorsement (depending on the requirement of the state board).
When should SPEC NOT be used?
The SPEC is not to be used to assess students nor for those who are entering practice for the first time.
- SPEC is not used for initial licensing purposes.
- SPEC is not designed for routine license renewal.
- SPEC does not replace NBCE Parts I, II, III, and IV.
Who can take SPEC?
Eligible applicants must meet all of the following criteria:
- Hold or have held a license to practice chiropractic.
- Provide written authorization from a state licensing agency in the form of a requirement or a request.
- Complete the NBCE application process and submit required fees prior to published deadlines.
Downloadable information brochures, applications and all required forms are available on this Web site. State licensing agencies have discretion over the use of SPEC scores in their jurisdictions. Candidates should contact the state(s) in which they are interested in seeking licensure for specific requirements.
How do applicants apply for SPEC?
Applicants should print the SPEC Information Brochure from this Web site and read and follow its instructions. Applicants must also print and complete the application and required forms and then submit them to the NBCE along with the required fees.
When can applicants take SPEC?
SPEC is administered six times a year at Prometric Testing Centers throughout North America. Examinees should schedule their own appointments on available testing dates. Results are reported quickly, ensuring state licensing agencies the shortest possible turnaround.
After verification and processing of the application is complete, the NBCE will mail a confirmation letter to the applicant. After receiving that letter, it is the applicant’s responsibility to contact the computerized testing center to make a testing appointment. The confirmation letter contains specific contact information and regarding appointment scheduling. See the SPEC Information Brochure for more information about testing dates and deadlines.
What is the format of SPEC?
SPEC consists of a total of 200 multiple-choice questions, organized into two sections.
- Questions that address the application of general knowledge and understanding required for patient evaluations.
- Questions relating to clinical case management
What is covered on SPEC?
Test questions are selected by a committee of state licensing board members. SPEC includes clinical case presentations that require that the examinee be able to demonstrate the appropriate clinical understanding and judgments required in unsupervised chiropractic practice.
The examination contains 100 questions related to the management of 25 clinical cases. SPEC also includes 100 multiple-choice questions addressing the application of general knowledge and understanding during patient evaluations.
For a more thorough description of SPEC, consult the Information Brochure.
How do potential candidates know if their state utilizes SPEC?
For the most current information on state licensing requirements, candidates should contact their state licensing authority for more information.
What is a passing score on SPEC?
The NBCE recommends a passing score of 375 for SPEC. This recommended passing score is based on input by a test committee of state licensing agency members. Individual licensing authorities may establish a passing score either higher or lower than the NBCE recommended passing score.
Because each individual licensing agency has sole determination of SPEC score utilization, examinees must contact the licensing agency of the state in which they intend to practice for any information concerning SPEC score requirements.
How do examinees learn of their scores?
The NBCE notifies examinees of their scores approximately three weeks after the examination.
How do examinees request a transcript of their SPEC results?
By submitting a SPEC application, an applicant gives the NBCE express authorization to provide a transcript of his or her examination results to the state chiropractic licensing agency or other licensing authority that requested or required the examination. This transcript will include only the most recent SPEC score, irrespective of the score result.
The NBCE will release a SPEC transcript only to the licensing authority that initially requested or required that candidate to take the SPEC. The NBCE will not release a transcript to any additional state without receiving a written request or requirement directly from that state along with an examinee’s written authorization to release score results. In some instances, a state may request or require a licensure candidate to retake the SPEC to provide a more current score.
One complimentary SPEC transcript is included in the SPEC fee. Each subsequent transcript request that meets the above requirements costs $25, paid to the NBCE in U.S. guaranteed funds. Examinees should allow two weeks for processing of a transcript.
Ethics and Boundaries Examination
What is the E&B?
The Ethics and Boundaries Examination (E&B) gives state boards a tool to assess the examinee's understanding of ethics and boundaries issues as they apply to chiropractic practice. The examination is designed to be administered to licensed or previously licensed chiropractors in special circumstances.
The E&B test plan is based on survey responses of state chiropractic licensing boards regarding the importance of understanding ethics and boundaries issues to practicing chiropractic in an ethical and legally appropriate manner. Successful completion of the E&B Examination requires that examinees demonstrate an acceptable level of understanding and judgments pertaining to appropriate relationships and interactions required in unsupervised chiropractic practice.
When should the E&B be used?
Each individual licensing board has the sole authority to determine how to utilize E&B examination results in its licensing and/or disciplinary decisions. The E&B examination is administered only at the request or requirement of a state board. Circumstances in which these exams might be used include (but are not limited to):
- Disciplinary action, including the knowledge of ethics and boundaries issues.
- Suspension, revocation or licensure relapse (depending on the requirement of the state board).
- State-to-state reciprocity/endorsement (depending on the requirement of the state board).
When should the E&B NOT be used?
- The E&B is not to be used to assess students nor for those who are entering practice for the first time.
- E&B is not used for initial licensing purposes.
- E&B is not designed for routine license renewal.
- E&B does not replace NBCE Parts I, II, III, and IV.
- E&B is not to be used in place of SPEC, but may be used in addition to SPEC.
- E&B is not to be used as a diagnostic psychological evaluation.
Who can take the E&B?
Eligible applicants must meet all of the following criteria:
- Hold or have held a license to practice chiropractic.
- Provide written authorization from a state licensing agency in the form of a requirement or a request
- Complete the NBCE application process and submit required fees and documentation prior to published deadlines.
Downloadable information brochures, applications and all required forms are available on this Web site. Examinees should contact the state(s) in which they are interested in seeking licensure for specific requirements.
How do applicants apply for the E&B?
Applicants should print the Post-licensure Examination brochure and application from this website and read and follow instructions. Candidates must also print and complete the application and required forms and then submit them to the NBCE along with the required fees.
When can applicants take E&B?
The E&B is currently offered six times per year at computerized testing centers nationwide.
After verification and processing of the application is complete, the NBCE will mail a confirmation letter to the applicant. The letter contains specific contact information regarding test site location and schedules. See the NBCE Examination Information brochure for the post-licensure examinations for more information about testing dates and deadlines.
What is the format of the E&B?
The NBCE Ethics and Boundaries Examination is a computer-based essay test requiring a written four-part response to five case scenarios. The essay response must focus on the ethical or boundary issue assigned to each scenario. Each case scenario will address a specific topic as selected from the E&B Essay Test Plan by individual state board committees. The test requires that the examinee demonstrate an understanding of the appropriate clinical protocols and judgments necessary in unsupervised chiropractic practice.
Scoring is based on the relevance and thoroughness of the examinee's responses to each of the five case scenarios. Content and expression of ideas are more heavily weighted in the grading than grammar, punctuation, or spelling. Please refer to the "E&B Essay Writing Exercise" for more information.
The examinee will be allowed a maximum of 60 minutes to compose a type-written response for each case scenario. Test appointments are scheduled for up to a total of 5 hours and 30 minutes to allow for the following: a brief introductory tutorial; five hours for the essay writing; two 10-minute breaks; and a post-test survey.
What is covered on the E&B?
The E&B test plan covers the following areas:
1. Boundary Violations
- Doctor with Patient
- Doctor with Staff
2. Fraud
- Billing and Coding
- Kickback/Steering Schemes
3. Doctor's Duties and Office Protocols
- Standards of Care
- Patient Records/Documentation
4. Unprofessional Conduct
- Alcohol/Substance Abuse
- Negligent/Inappropriate Behavior
How do potential candidates know if their state utilizes the E&B?
For the most current information on state licensing requirements, candidates should contact their state licensing authority for more information.
What is a passing score on the E&B?
The NBCE recommends that examinees must pass all five essays to receive credit for completion of the examination. Each E&B essay has a possible maximum of 16 points; 12 points is a passing score. Detailed E&B scoring criteria are available here.
Attaining an NBCE recommended passing score does not under any circumstances guarantee acceptance by a state licensing agency. The use of SPEC and/or E&B scores for any purposes is at the discretion of state licensing boards.
E&B Essay Retake Policy
- An examinee scoring below 12 points on three or more essays will retake the entire examination from topics originally designated by the state board with new scenarios randomly selected.
- An examinee scoring 12 points or above on three or more essays will retake only failed portions of the examination; topics will be as originally designated by the state board with new scenarios randomly selected.
How do examinees learn of their scores on the examination?
The NBCE verifies scores and mails them directly to examinees and licensing authorities, approximately three weeks after the examination administration. The NBCE issues no certificate of completion for its post-licensure examinations (SPEC and E&B). Examinees will not receive a score from the testing center at the end of the examination.
How do examinees request a transcript of their E&B results?
By submitting a E&B application, an examinee gives the NBCE express authorization to provide a transcript of his or her examination results to the state chiropractic licensing agency or other licensing authority that requested or required the examination. This transcript will include only the most recent E&B score, irrespective of the score result.
The NBCE will release a E&B transcript only to the licensing authority that initially requested or required that candidate to take the E&B. The NBCE will not release a transcript to any additional state without receiving a written request or requirement directly from that state along with an examinee’s written authorization to release score results. In some instances, a state may request or require a licensure candidate to retake the E&B to provide a more current score.
One complimentary E&B transcript is included in the E&B fee. Each subsequent transcript request that meets the above requirements costs $25, paid to the NBCE in U.S. guaranteed funds. Examinees should allow two weeks for processing of a transcript.
Diplomate Status
Why is the term "diplomate" not used to describe NBCE certificate holders?
The term “DIPLOMATE” as used to describe a National Board of Chiropractic Examiners’ (NBCE) certificate holder is not a valid designation or term. This outdated term continues to be widely misused to describe individuals who successfully complete the National Board examinations and subsequently receive an NBCE Certificate of Attainment.
In 1982, the NBCE rescinded the “Diplomate” terminology to avoid any misunderstanding of the distinction as it applied to specialty health care councils. Only those individuals who received an NBCE Diplomate certificate issued upon successful completion of Parts I and II through the March 1983 administration may use the term “Diplomate” to describe a credential from the NBCE. Any other use of “Diplomate” in any manner, including advertising or promotional materials, whether intentional or unintentional, is misleading and confusing to the general public and is not permissible. Those who completed Part I and Part II prior to 1983 should indicate, "holds NBCE Diplomate Certificate 19XX."
Today, examinees who successfully complete NBCE Parts I, II, III and IV are awarded an NBCE Certificate of Attainment. Because NBCE examinations are only one portion of the licensure requirements determined by individual states, mention of the NBCE name in promotional materials could be misleading if not fully explained to and fully understood by the public. States may view use of the term “NBCE Diplomate” as a misstatement of credentials and as a cause for action against licensure.
Even though the NBCE issues a certificate of attainment upon completion of Parts I, II, III and IV, use of the term "Board Certified by the NBCE" can be considered misleading as it may appear the doctor has a credential above another licensed doctor of chiropractic. In most states, successful completion of NBCE Parts I, II, III and IV is a prerequisite to licensure just as graduation from a chiropractic college is, but does not represent post graduate of added specialty status.
Therefore, please be advised that any inappropriate use of the National Board of Chiropractic Examiners’ name may result in legal action being taken against the offending party.
