The National Board of Chiropractic Examiners (NBCE) has released its 2025 Practice Analysis, offering a comprehensive, data-driven perspective on the state of chiropractic in the U.S. With 4,041 responses from chiropractors nationwide, the report provides a research-informed account of the core competencies, clinical practices, and evolving trends in chiropractic care across the U.S. The report serves as a foundational tool for ensuring the validity of licensure exams, guiding educational programs, and informing stakeholders within and beyond the profession.
Chiropractic continues to adapt in response to the changing healthcare landscape. Remaining aligned with public needs, scientific progress, and new models of practice is essential to its future. This is where the Practice Analysis plays a pivotal role. The study surveys practicing chiropractors across the country to gather insights on the procedures they perform, the knowledge they apply, and the responsibilities they carry each day.
The results inform the content of NBCE’s licensure exams to align with the realities of contemporary chiropractic practice. This ensures that when a new chiropractor earns their license, the public can have confidence that the practitioner has been evaluated on the very skills and knowledge required in practice.
The Practice Analysis offers value well beyond examinations. For the profession, it clarifies the role of the chiropractor today, and strengthens professional identity with data-based insights. Beyond chiropractic, the findings provide insights into professional competencies, give policymakers and insurers transparency, and highlight how chiropractic contributes to the broader healthcare system.
Key Findings from the 2025 Report
The 2025 Practice Analysis captures how the chiropractic profession continues to evolve in both who is practicing and how care is delivered. These findings provide a snapshot of today’s profession and a baseline for understanding how chiropractic adapts to patient needs and the broader healthcare ecosystem.
Demographic Trends:
- The majority of the world’s chiropractors are located in the U.S.
- Gender diversity is increasing. Women now make up 30% of the workforce, nearing 50% among recent graduates.
- Ethnic representation is improving with growing representation of non-White chiropractors reflecting greater inclusivity of the profession.
- The age distribution of chiropractors in the U.S. mirrors previous survey patterns, with the majority aged 50 or older (58%). The largest group is chiropractors aged 50–59 (25%), while
- those under 30 represent the smallest segment at just 5%.
Practice Settings:
- 49% of chiropractors are solo practitioners; 36% work in multi-doctor offices, and 12% in multidisciplinary or integrated health facilities.
- About 40% provide 30–39 hours of patient care weekly.
- Most identify as general practitioners focusing on spine and whole-body wellness, but many also specialize in rehabilitation, sports, pediatrics, and community health.
Professional Functions:
- Chiropractors’ work is grouped into four domains:
- Patient Assessment – history-taking, examination, diagnostics.
- Case Management – planning, monitoring, and modifying care.
- Communication – reporting findings and coordinating with other providers.
- Treatment – spinal and extremity adjustments, soft tissue therapy, and rehabilitative care.
- They commonly manage:
- Acute/chronic back and neck pain
- Joint dysfunctions (spine and extremities)
- Postural syndromes and traumatic injuries
- Neurogenic/joint pain, including disc syndromes, radiculitis, osteoarthritis, and headaches.
- Chiropractors report spending the most time on examination, diagnosis, treatment, and case management, with increasing emphasis on communication, documentation, and coordination of care.
Together, these findings provide a clear picture of how chiropractors practice today and how the profession continues to evolve in response to patient needs and healthcare trends.
Trends and the Future Outlook
The Practice Analysis highlights a profession that is rapidly changing and expanding its role within modern healthcare. Key trends shaping the future of chiropractic include:
- Growing Diversity and Gender Balance: The profession continues to make notable progress toward gender parity and broader cultural representation, reflecting the changing demographics of the healthcare landscape.
- Deeper Healthcare Integration: Chiropractors are increasingly recognized as vital members of multidisciplinary healthcare teams, contributing to whole-person wellness and research-backed patient care.
- Technological Transformation: Advancements in artificial intelligence, telehealth, and digital health records are reshaping both chiropractic education and clinical practice, improving access, precision, and continuity of care.
- Data-Driven and Research-Focused Practice: Ongoing investment in clinical research and outcomes-based data is strengthening the scientific foundation of chiropractic and supporting greater collaboration with other medical disciplines.
- Enhanced Public Awareness: Strategic communication efforts are needed to improve understanding of chiropractic education, scope, and impact, ensuring the public recognizes the profession’s value in preventive and restorative health.
- Challenges Ahead: The profession must continue to address educational debt, workforce sustainability, and inconsistent state licensure standards to maintain growth and accessibility in the years ahead.
The Practice Analysis affirms that chiropractic stands at a pivotal point, one defined by scientific maturity, expanding influence, and a deepened commitment to patient-centered, evidence-informed care.
Supporting the Profession and the Public
At its core, the Practice Analysis provides an objective picture of chiropractic today, offering data that supports consistency, safety, and professional integrity. By documenting what chiropractors do in practice, the Practice Analysis ensures that NBCE Part III and Part IV examinations remain legally defensible, psychometrically sound, and aligned with the realities of the profession. At the same time, it provides the chiropractic community with a reliable mirror that reflects both who we are today and where we are headed tomorrow.
To me, as a psychometrician and project lead, the Practice Analysis functions as the empirical cornerstone for establishing the content validity of licensure assessments. Through systematically identifying the knowledge domains, task frequencies, and critical competencies required for competent chiropractic practice, the analysis directly informs the test blueprint, guides item development, and ensures alignment with real-world clinical performance standards.
The data generated support defensible decisions around test domain representation, content weighting, and standard setting, which are central to constructing psychometrically sound instruments. Moreover, the Practice Analysis aids in documenting the linkage between test content and job requirements, an essential criterion under professional testing standards. It also provides a structured framework for engaging subject matter experts, managing complex workflows, and translating empirical job analysis data into valid assessment specifications that withstand legal and professional scrutiny.
To explore the findings from the Practice Analysis, download the full report here.
Dr. Igor Himelfarb is the Director of Psychometrics and Research at NBCE, where he oversees scoring operations and leads psychometric research to ensure the validity, reliability, and fairness of the organization’s examinations.
