Board of Chiropractic Examiners

Application/Forms

Initial License Applications

• Chiropractic License Application, #08-0672, Revised 10/1/16. Application and instructions for licensure by examination or for licensure by credentials.
• Courtesy License Application, #08-4500, Revised 9/23/16. Application and instructions for out-of-state chiropractic physicians working at a special athletic, cultural, or performing arts event in the State of Alaska.
• Chiropractic Application for Locum Tenens Permit, #08-4319, Revised 9/23/16. Application and instructions for out-of-state chiropractic physicians substituting in an Alaska-licensed chiropractic practice.

Renewal and Reinstatement Applications

• Biennial Chiropractic Physician License Renewal Application, #08-0094, Revised 10/1/16.

• Chiropractic License Reinstatement Application, #08-4170, Revised 9/23/16. Application and instructions for reinstating a license that has been lapsed or in retired status for more than two years but less than five years.
• Chiropractic License Reactivation Instructions, #08-4563, Revised 9/23/16. Instructions and information for reactivating an inactive or retired status license.

Please do not submit your certificates with your renewal application. Only submit documentation of your continuing education activity if you are notified that you have randomly been selected for an audit.

NOTE: Licenses lapsed or in retired status for more than five years may not be reinstated. See the initial license application.

Miscellaneous Forms

• Continuing Education Course Approval Application for Chiropractors, #08-4640, Revised 10/1/16.
  Use this form only if you are licensed in Alaska
• Continuing Education Activity Log
• Continuing Education Course Approval Application for Providers, #08-4003, Revised 10/1/16.
• Chiropractic Specialty Designation Application, #08-4061, Revised 9/23/16. Application to add a postgraduate specialty to an existing chiropractic license.
• Request for Peer Review, #08-4371, Revised 9/26/16.
• Application for Appointment to Utilization Review Committee, #08-4370, Revised 11/29/16.
• Name and/or Address Change, or Duplicate License, #08-4291, Revised 04/1/16
• Request for License Verification
• Credit Card Authorization Form