Request Forms

Name Change (PDF)

Address Change (PDF) (Also available online)

Duplicate (PDF) (Also available online)

Verification of licensure to another state - request ONLINE

NOTE: As a result of document fraud and in an effort to protect its licensees, the Board will only provide direct source verification of your license to another state licensing agency.

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Contact

State Board of Chiropractic

P.O. Box 2649

Harrisburg, PA 17105-2649

Phone - (717) 783-7155

Fax - (717) 787-7769

ST-CHIROPRACTIC@pa.gov