Our mission: to protect the public by promoting excellence in chiropractic regulation through service to our member boards
Our vision: The FCLB is the premier international resource for information and consolidated services for ensuring the safe, ethical practice of chiropractic

To apply for FCLB's Passport program, please complete and submit the form below.  If your "home license" is from a member jurisdiction, you will be invoiced $150 for processing once your complete application has been submitted.  For non-member jurisdictions, the fee is $300. Fees are non-refundable. For information about the program click here. Fields marked with an * are required. Contact Information

First Name* Last Name* Suffix Jr. Sr. II III IV V Email Address* Re-enter your email address* Phone Address* City* State or Province* Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico US Virgin Islands New Zealand Nova Scotia Quebec Country* United States of America New Zealand Canada Postal Code* Aliases (including maiden name) Individual (not clinic) US NPI (if applicable) Graduating Chiropractic College and Year Please upload a current 2" x 2" passport-quality photo of yourself for your Passport ID Badge File Size: 1000KB Maximum File Types: .jpg .bmp .png Licensure Information Please include all current and previous chiropractic licenses.  Your "Home License" will be considered your primary active license for your Chiropractic Passport registration.    Home License Jurisdiction* Home License Number* Please list all other chiropractic licenses you hold (jurisdiction and number) If your chiropractic license(s) has ever been disciplined by a state or federal agency, please explain. Check here to indicate you understand that the FCLB will verify your license status through the CIN-BAD database. Malpractice Passport participants are required to follow the malpractice insurance requirements of their home jurisdiction. FCLB does not endorse any individual malpractice carrier. Please select your malpractice carrier:* --please select-- Not required in my jurisdiction NRCME OUM Benefit Services Group Princeton Insurance Company Promed International Other (please specify) If you selected "other," please specify Current policy expiration date:   Sports Medicine Licensure Clarity Act Documentation Please provide the name of the school or team you are associated with: Please provide a copy of the provider/team contract: File Size: 3000KB Maximum File Types: .docx .jpg .jpeg .jpe .bmp .png .doc .pdf .zip Please upload a copy of malpractice notification correspondence: File Size: 3000KB Maximum File Types: .docx .jpg .jpeg .jpe .bmp .png .doc .pdf .zip Diplomates and Specialty Certifications Please select any diplomates or specialty certifications you hold. Please note: FCLB does not endorse or approve specific specialty certifications. DIPLOMATES Neurology None ACNB CBCN IBCN Orthopedics None ABCO ACO Pediatrics None CCP ICCP Occupational None ACBOH Sports None ACBSP Radiology None ACCR Internists None DABCI Nutrition None CBCN ACBN Acupuncture None DABCA CERTIFICATIONS Sports None CCSP CCSMP Pediatrics None CACCP Acupuncture None IACA Rehabilitation None ACRB Trauma None CCST Forensics None ABFP Veterinary None ACCC JURISDICTION CERTIFICATIONS Mark any that apply. Canada CCO(C) CCR(C) CCPOR(C) RCCSS(C) United States of America NRCME Arizona Physical Therapy Certificate Acupuncture Certificate Colorado Acupuncture Certificate Animal Certificate Electrotherapy Certificate District of Columbia Ancillary Procedures (Acupuncture) Certificate Ancillary Procedures (Physiotherapy) Certificate Florida Acupuncture Certificate Georgia Physiological Therapeutics Certificate Kentucky Chiropractic Orthopedics Chiropractic Roentgenology Louisiana X-Ray Proficiency Certification Maine Chiropractic Acupuncture Certificate Maryland Physical Therapy Endorsement Minnesota Animal Chiropractic Registration Acupuncture Registration Missouri Acupuncture Certificate New Jersey Electro-Diagnostics Certificate New Mexico Certified Advanced Practice Chiropractic Physician North Dakota Acupuncture Certificate Ohio Acupuncture Certification Oklahoma Animal Chiropractic Injectables Oregon Minor Surgery/Proctology Certificate Natural Childbirth Certificate Pennsylvania Adjunctive Procedures Certificate Rhode Island Physiotherapy Certificate South Carolina Physiotherapy Endorsement South Dakota Acupuncture Certificate Tennessee Acupuncture Certificate West Virginia Physiotherapy Certificate Wisconsin Therapeutic Procedures & Nutritional Counseling Certification OTHER DIPLOMATE OR SPECIALTY CERTIFICATION PROGRAMS Please list all other chiropractic certifications or diplomates (and expiration dates) not included above. If you have listed any certifications or diplomates not included above, you will need to submit a verification. Click here for the instructions and form. Background Check FCLB Requires a background check for Passport registration. Click here for the instructions and form. Please check below to indicate that you understand the background check is essential to this verification process and failing to complete it will prohibit you from obtaining and FCLB Passport. I agree to submit the results of the specified background check to the FCLB Government-Issued Passport (for travel) Issuing Country ID or Card Number Expiration Date Attestations Please check the following statements to verify that you will comply. I agree to promptly notify the FCLB of any lapse, inactive status, or non-renewal of my "home" chiropractic license. I agree to promptly notify the FCLB of any known governmental investigation of any chiropractic license I hold. I agree to promptly notify the FCLB of any adverse action imposed on any chiropractic license I hold. I agree to promptly notify the FCLB of any malpractice judgement or settlement I am involved in. I agree to promptly notify the FCLB of any criminal or civil investigation I am involved in, including any subsequent finding of fault or guilt. I agree to adhere to the scope of practice standards associated with my "home" chiropractic license. I agree to publicly display the Chiropractic Passport identification while engaged in clinical practice at applicable venues. Once you click "submit" your form will be reviewed for completeness and you will be invoiced the $150 application fee. Please note that incomplete applications or applications with outstanding balances will not be processed. Submit * Required