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ForwardGenetic Aetiology of Adolescent Idiopathic Scoliosis (AIS): Chiropractic’s Role (Weiner, Online 2026)
Overview
This course will dive into the aetiology of adolescent idiopathic scoliosis as well as treatment and management options for the practicing chiropractor.
Credits
4.0 Hours of General CE
Pending States: CA, NV, HI, FL
Duration
This course is available through December 31. Download or print your certificate before that date.
Learning Objectives
By the end of the seminar, participants will have a knowledge of:
- The different types and classification of tethered oral tissue
- The possible reason for incidence of congenital TOTs currently
- Specific anatomy (cranial/oral/lingual) specific to TOTs and breastfeeding function
- The clinical applications of normal and pathological function for all structures
- Accepted modalities of correction in the Medical world and controversies/barriers that exist
- The scope of the Chiropractor- Identifying when surgical referral is necessary
- Ideal collaboration with other birth professionals
About This Online Seminar
Online CE at Life West is simple and engaging.
- Check on the right of this screen or under the CREDITS tab to see if the seminar is approved for CE in your licensure state(s).
- You must be logged in to your Life West CE account in order to access the seminar. Click on the REGISTER tab to register and begin.
- The seminar consists of video, readings, and one or more quizzes. You do not need to complete the seminar in one sitting, and you may return to it at any point.
- Once in the seminar, follow the MENU of steps on the left side of the screen. Click through the steps to move through the program.
- When you have completed the evaluation, you can PRINT YOUR CERTIFICATE yourself, on the spot.
If you have questions or concerns along the way, contact Life West Postgraduate & Continuing Education at [email protected] or 510.780.4508 during our regular business hours 9am-5pm Mon-Fri. Please expect a response within 1-2 business days.
Introduction
- Definition
- Scoliosis is any abnormal sideways curvature of the spine measuring at least 10 degrees on an x-ray. Scoliosis is often defined as spinal curvature in the “coronal” (frontal) plane. While the degree of curvature is measured on the coronal plane, scoliosis is actually a more complex, three-dimensional problem which involves the Coronal plane as well as the Sagittal and Axial plane. Sagittal and coronal curve, kyphoscoliosis occurs most commonly in the region of the thoracolumbar spine, it can also be noted in the cervicothoracic region as well. Moderate kyphoscoliosis is a Cobb angle ranging from 25 to 100 degrees, whereas severe kyphoscoliosis is a Cobb angle greater than 100 degrees. Abnormalities in curvature and its clinical impact are affected by the severity and location of the curvature, the number of vertebrae involved, and the degree of axial rotation. These may affect both energy consumption as well as pulmonary function While scoliosis is not a disease, in rare cases it can be caused by a disease. More often, however, scoliosis develops from a yet unknown cause during adolescence or from spinal degeneration during adulthood. It is seen to begin in AIS at the age of 10-15. Females are eight times more likely to progress to a curve magnitude that requires treatment. The onset has been tied to the commencement of secondary sex characteristics. More specifically, skeletal changes as seen by the eruption of the wisdom teeth. It appears that the hormonal stress on the system plays a role. A role that we will investigate in this presentation. All derangement of the facets change the proprioceptive input via the mechanoreceptors and over stimulate the brain in a flight or flight syndrome.
- Scoliosis is estimated to affect up to 5.2% of the general population. (70) Keep in mind that in typical year all cancers affect 4.39% of the population. (71) The average scoliosis patient will suffer a 14-year reduction in their average life expectancy, this is unacceptable, this is a problem of epidemic proportion if considering CDC statistic standards for epidemic. Every year, scoliosis patients make more than 600,000 visits to private physician offices, an estimated 30,000 children are fitted with a brace and 38,000 patients undergo spinal fusion surgery.
- Differentiation Hour 1
- Structural scoliosis - By far the most common category of scoliosis. It involves spinal rotation in addition to the side-to-side curvature of the spine. This type of scoliosis affects the spine’s structure and is considered permanent unless the spine receives treatment. Structural scoliosis is typically considered more serious because it does not straighten out on its own and can potentially result in more spinal deformity.
- Idiopathic scoliosis (AIS) accounts for about 8 in 10 cases of scoliosis. This type of scoliosis typically presents during adolescence, but it can also start earlier in childhood or infancy. What causes idiopathic scoliosis is currently unknown. Some research indicates genetics plays a part, but other factors are also likely involved and continue to be studied.
- Degenerative scoliosis (adult scoliosis) a common condition that occurs later in life as the joints in the spine degenerate.
- Osteoporosis
- DDD
- Zygapophysis scarring (unilateral)
- Neuromuscular scoliosis sometimes develops in individuals who cannot walk due to a neuromuscular condition such as muscular dystrophy or cerebral palsy. This type of scoliosis may also be called myopathic scoliosis.
- Congenital scoliosis develops in utero and is present in infancy. A rare condition, affecting 1 in 10,000, it can result from malformations in the vertebrae or other causes. In most cases the spinal curve must be corrected surgically.
- Spina bifida
- Birthing Issues
- Torticollis
- Strabismus
- Plagiocephaly
- Vertebral Malformation scoliosis appearing later
- Klippel–Feil syndrome (KFS)
- Complications from Castellvi classification IIa, IIb, IIIa, IIIb, IV
- Due to uneven bone growth.
- Hemivertebrae
- Craniomandibular
- Cranial
- Birth trauma- torticollis
- Plagiocephaly (birth trauma /or positional)
- Mandibular
- Dentition
- Congenital osseous abnormalities
- Iatrogenic Orthodontics
- Cranial
- Pathological Rarely, scoliosis is caused by a spinal lesion or tumor. Usually, patients who are younger (age 8 to 11) than typical scoliosis patients will experience symptoms such as pain, numbness and a left-curving thoracic spine. A physician who sees any or a combination of these symptoms will order additional diagnostic tests, such as an MRI, to rule out the possibility of spinal tumor or other lesions as a cause of scoliosis. As ten percent of these patients were found to have an underlying associated condition such as spondylolisthesis, syringomyelia, tethered cord, herniated disc or spinal tumor.
- Secondary and disease-related causes include degenerative and senile changes, inflammatory disease, posttraumatic fractures, iatrogenic post-surgical changes, and repetitive microtraumas from overuse. As discs naturally degenerate, these changes can lead to alterations of normal biomechanics of the spine resulting in increased anterior wedging. Other causes include infectious etiologies, neuromuscular (cerebral palsy, muscular dystrophy, polio, Freidrich ataxia, spinal muscular atrophy, spina bifida, etc.), and connective tissue sources (Ehlers-Danlos syndrome, chondrodysplasia, Marfan syndrome, etc.).
- Scheuermann disease, also known as juvenile kyphosis or juvenile discogenic disease, is a slowly progressive disorder of the spine most commonly affecting adolescents and involves the wedging of 3 or more adjacent vertebrae at an angle of more than 5 degrees. In this disease, kyphosis is caused by osteochondrosis of vertebral secondary ossification centers. Radiographic imaging may note endplate narrowing and Schmorl's nodes.
- Nonstructural scoliosis also known as functional scoliosis, results from a temporary cause and only involves a side-to-side curvature of the spine (no spinal rotation). The spine’s structure is still normal. If a person with nonstructural scoliosis were to bend forward or lay down, the scoliosis curve would likely go away while held in that position.
- Muscle spasm when a major muscle in the back starts to spams, the spine is pulled in one direction and a sideways curve may result. Muscle weakened as well….
- Difference in leg heights When one leg is significantly longer than the other from actual bone deficiency or apparent leg length discrepancy from foot arch loss, or ankle pronation the scoliosis curve may be observed only while standing
- Inflammation. If an area of the body to one side of the spine or the other starts to become inflamed, a scoliosis curve can result. Some possible causes could be appendicitis or pneumonia.
Beginning our journey discussing AIS – Hour 2
- The presentation that AIS is genetic in nature has appeared to rule Chiropractic out of the picture. On the contrary, we will discuss here how that places Chiropractic front and center in the care of scoliosis when compared to the allopathic alternatives.
- The Zebra Fish and CFS
- Historic misconception
- Correction of CSF flow disruption was caused by scoliosis and how correction of scoliosis will aid in stabilizing Important CSF flow.
- Zebra fish
- Catanzariti- ciliopathology
- Spermatic flagella
- Fellopian cilia
- DNA= Destiny
- Epigenetics- the way in which our body perceives the environment and hence how it responds to those external and internal environment conditions through the modification of the expression of our genetic code.
- Historic misconception
- Chiropractic and epigenetics
- Chiropractic modifies brain activity and hence perception of int / ext environment
- Chiropractic paradigm can impact all classifications
- Subluxation
- Toxins
- Traumas
- Thoughts
- Lipton
- Upledger
- Subluxation
- ‘Unequivocally, recent evidence suggests that the dynamic regulation of gene expression through epigenetic mechanisms is at the interface between environmental stimuli and long lasting molecular, cellular and complex behavioral phenotypes acquired during periods of developmental plasticity.’ (12)
- nervous system unencumbered by subluxation will greatly enhance the way in which external and internal signaling reaches the nervous system and brain, and now we know even to the chromosomal level. (14, 15, 16, 17) This has been documented even in medical literature, ‘Nerve impingement can interfere with the brain's ability to communicate with the muscles, organs, and cells and can result in the loss of motor function, sensory function, or both.’ (18) Different studies with animal models have demonstrated that chiropractic therapies mediate neuroplasticity, specifically through modulation of neurotrophins.
- Epigenetic scientists including Dr Feinberg, professor of molecular medicine and director for Epigenetics at Hopkins’ Institute for Basic Biomedical Sciences, have determined that ‘the environment of the cell is the epigenetic control of the gene that determines the expression of the gene’. (13)
- Epigenetic inheritance allows an organism to continually modify its gene expression to environmental change without affecting its DNA.
- chiropractic impacts the methylation processes which are a prime mover in genetic transcription and replication. (20) Dr. Feinberg in his study stated ‘Cellular biologists and epigenetic geneticists understand that methylation of the gene is a key to epigenetic control. This control is a result of the cell responding to a changing environment of the body either macro, micro, internal or external.’ (21) In the article ‘Epigenetic Mechanisms of Integrative Medicine’, Riya Kanherkar, Deepak Chopra, et al, demonstrated the effects of alternative medicine including chiropractic have on the DNA methylation and epigenetic modification to DNA code. (22)
- Kanherkar states from another study ‘It is well known that epigenetic influences acting on a pregnant mother also affect the in-utero foetus’. (23) This was supported by Barron-Cohen’s work. (24) There is ‘developmental plasticity’, where ‘a single genotype, influenced by specific intrauterine events, has the capability to produce different phenotypes. (25). Furthermore, these epigenetic influences have been observed to span across at least 4 generations. Crossing four generations shows that genetic change is inherited. Therefore, the study suggests a possible role for chiropractic treatment to the mother in promotion and enhancement of long-term foetal and infant health benefits through epigenetic pathways extending to future generations. We know that spinal manipulation techniques have been used to relieve symptoms arising from chronic low back pain, but they have also proven efficacy of treatment of vertebral subluxations in diabetic patients, (26) and this was substantiated in DeVocht’s study. (27) There is research that even suggests that long-term chiropractic therapy may provide a tangible solution to chronic diseases that were previously thought to be genetic in nature.
- chiropractic has shown to maintain and elongate the telomere of the DNA creating greater DNA/cell health and lifespan. A ground breaking study by Fedorchuk and McCoy (30) found that ‘correction of cervical lordosis and forward head position improved the sagittal spinal alignment and posture and was associated with lengthened telomeres, improvement in both quality of life, and autonomic nervous system function.’ There have been other studies discussing the epigenetic modification effect on previously considered genetic conditions. One such study discussing that the immune system is highly sensitive to shortening of telomeres as its competence depends strictly on cell renewal and clonal expansion of T- and B-cell populations. 3 (31) There has been mounting evidence of a causal role for telomere dysfunction in a number of degenerative disorders: ‘Their manifestations encompass common disease states such as idiopathic scoliosis, pulmonary fibrosis and bone marrow failure. Although these disorders seem to be clinically diverse, collectively they comprise a single syndrome spectrum defined by the short telomere defect.
- thoughts (emotional stress), as well as toxins and traumas (3 T’s) produce epigenetic changes that modify the expression of the genetic code and is then passed down to at least 4 generations. (33, 34) Again, finding the genetic trait modified to the 4th generation is considered evidence that the change has been a genetic change and is not from ‘nurture’. Considering thoughts, i.e. mental stress, Dr. Rachel Yehuda, Director of the Traumatic Stress Studies Division at the Icahn School of Medicine at Mount Sinai in New York City, reported a study in 2015 on the children of 40 Holocaust survivors. She found that ‘they had epigenetic changes to a gene linked to their levels of cortisol, a hormone involved in the stress response’. She also found ‘a distinctive pattern of DNA methylation’, another epigenetic marker. This study concluded that ‘both parents and unborn children were affected on a genetic level’. (35) Another study highlighting stress as an epigenetic force was the seminal research on the Dutch Hunger Winter, an extended period of famine that took place towards the end of World War II when the Nazis blocked food supplies in October 1944, thrusting much of the Netherlands into famine. When the Dutch were liberated in May 1945 more than 20,000 had died of starvation. Pregnant women were particularly vulnerable, and the famine impacted their unborn children for the rest of their lives. Scientists found that those who had been in utero during the famine were a few pounds heavier than average. The thinking goes that the mothers’ bodies, because they were starving, underwent an epigenetic change that turned off a gene in their unborn children involved in burning the body’s fuel. This study demonstrated that when the children reached middle age, they had higher LDL (‘bad’) cholesterol and triglyceride levels. They also suffered higher rates of obesity, diabetes, cardiovascular disease, and schizophrenia. When scientists looked into why, they found that ‘these children carried a specific chemical marker, an epigenetic signature on one of their genes’. (36 )
HOUR 3
- maternal stress causing epigenetic changes concerning the foetus’ sensitivity to certain hormones. (37, 38) Contrarily, it has as well been put forward that Eu-stress (positive stressors) can positively affect health, reduce the ageing process and decrease the incidence of cancer through induced stress suppression through epigenetic mechanisms. ‘We propose herein that stress may stimulate genetic adaptations through epigenetics that, in turn, modulate the link between the environment, human lifestyle factors, and genes.’ (39
- Plaza-Manzano states in his study that chiropractic adjustments have been shown to provide Eu-stress to the nervous system and entire body through stimulation and production of neurotensin, oxytocin, and cortisol. (40) Other studies have demonstrated how chiropractic affects mood through brain stimulation. (41) There have been studies documenting how stressors in the mother have caused genetic changes in the foetus. This was particularly enlightening as concerning autism. (42, 43) There have been multiple studies demonstrating how even stress on the father, not just the gestational mother, has affected further generations. This demonstrating once again epigenetic inheritance, not just in utero and/or nurture. Surprisingly this was passed only to the male offspring leaving the daughters unaffected, signalling a possible sex link pattern.
- There is much scientific support for the notion that chronic activation or deactivation of supraspinal systems, as we know through subluxation, will lead to maladaptation of homeostatic mechanisms, causing the impairment of processes within the body, and ultimately leading to visceral disorders. Change in supra-spinal neurophysiological efferent activity is increasingly Asia-Pacific Chiropractic Journal Weiner & Blum, 4 being used to explain ‘stress’ related disease. These responses are often referred to as ‘stress responses’ and include the activation of the hypothalamic-pituitary-adrenal axis and sympathoadrenal system, resulting in the consequential secretion of multiple hormones including corticotrophin releasing hormone, adrenocorticotropin hormone, cortisol, norepinephrine and epinephrine.
- There is much scientific support for the notion that chronic activation or deactivation of supraspinal systems, as we know through subluxation, will lead to maladaptation of homeostatic mechanisms, causing the impairment of processes within the body, and ultimately leading to visceral disorders. Change in supra-spinal neurophysiological efferent activity is increasingly Asia-Pacific Chiropractic Journal Weiner & Blum, 4 being used to explain ‘stress’ related disease. These responses are often referred to as ‘stress responses’ and include the activation of the hypothalamic-pituitary-adrenal axis and sympathoadrenal system, resulting in the consequential secretion of multiple hormones including corticotrophin releasing hormone, adrenocorticotropin hormone, cortisol, norepinephrine and epinephrine.
- the fifth level of epigenetic mechanisms are oxidative degeneration of chromosomes. Repair to these chromosomes was documented by reducing the oxidative stress. In a landmark study published in the Journal of Vertebral Subluxation Research, chiropractors collaborating with researchers at the University of Lund found that chiropractic care could influence basic physiological processes affecting oxidative stress and DNA repair. (49) ‘Serum thiols are a measure of human health status. It is a surrogate estimate of DNA repair enzyme activity, most notably poly ADP – ribose polymerase or PARP. Campbell and Kent demonstrated the effects of short-term and long-term chiropractic care on serum thiol levels in asymptomatic subjects positively effecting DNA health.’ (50) The implication is enormous for chiropractic because it has been proven that chiropractic care can promote epigenetic changes in the parent that will continue to change the genetics of future generations. What greater reason to care for young people of child bearing age and infants than this? As one can see the nature and the etiology of scoliosis places chiropractic front and center. Chiropractic is shown to affect epigenetics through 5 different avenues of action
Allopathic alternatives- Hour 4
- Bracing - considered the least invasive therapeutic alternative. However, the sores and cutaneous ulcers they can cause are a serious side effect and a major cause for patient noncompliance. Bracing has been the standard method of trying to protect patients from needing surgery ever since a brace was developed in the 1940s, said Weinstein, MD, of the University of Iowa. ‘But it has never really proven to be effective in any study. Many bracing treatments are unnecessary. We’re unnecessarily bracing two patients to get the one patient who actually needs it. We are still over-treating patients’ Weinstein said, ‘furthermore, on closer examination of the data we find that nearly half of the participants in the non-braced control group during the trial did not have curve progression to the point of needing surgery’. The same was true for 41 percent of patients in the bracing group, who were non-compliant and actually spent very little time wearing Asia-Pacific Chiropractic Journal Weiner & Blum, 5 their braces. These statistics bring the efficacy of bracing into question. (51) A second meta study found that 60% to 70% of the patients referred to bracing are Risser 0 and 30% to 70% of this group will not wear the brace enough to ensure treatment efficacy. Furthermore, Risser 0 patients who reach the accelerated growth phase with a curve ≥40° are at 70% to 100% risk of curve progression to the fusion surgical threshold despite proper brace wear. Skeletally immature patients with relatively large magnitude scoliosis who are noncompliant are at a higher risk of failing brace treatment. (52)
- Physiotherapy
- Real outcome papers (start of treatment in immature samples/end results after the end of growth; controlled studies in adults with scoliosis with a follow-up of more than 5 years) have not been found. Some papers investigated mid-term effects of exercises, most were retrospective, few prospective and many included patient samples with questionable treatment indications.
- may be effective for improving measures of spinal deformity for people with AIS, but the evidence is of very low quality.
- This unbiased literature review has revealed poor quality evidence supporting the use of exercise therapy in the treatment of AIS. Well-designed randomised controlled studies are required to assess the role of exercise therapy in AIS.
- Why physiotherapy is ineffective? The spine and muscles are no more the cause of scoliosis than glaucoma is the cause of diabetes.
- Physical therapy research claims good results when used in conjunction with bracing. Bracing is not effective.
- Surgical intervention
- 40 % of operated patients with idiopathic scoliosis were legally defined as severely handicapped persons after surgery. (53) In their study, ‘Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature’, Weiss and Goodall found that, ‘Scoliosis surgery has a varying but high rate of serious complications. A medical indication for this treatment cannot be established in view of the lack of evidence of efficacy. The rate of complications may even be higher than reported. Long-term risks of scoliosis surgery have not yet been reported upon in research. Trials with untreated control groups in the field of scoliosis raise ethical issues, as the control group could be exposed to the risks of undergoing such surgery.
- both surgically treated and brace-treated patients had more degenerative disc changes than the control participants as found by Danielsson and Nachemson is a concerning finding.
- outcomes indicated that the initial average loss of the spinal correction offered by surgery was 3.2 degrees in the first year and 6.5 after two years with continued loss of 1 degree per year throughout life. It appears that in patients with a 50-degree curve, who were to undergo surgical correction, the curve would completely return after twenty years. This is observed through the need to repeat surgical intervention especially when the surgery was conducted on young children.
- Dr. Paul Harington, inventor of the surgery for scoliosis with implanted metal rods, stated as far back as 1963, ‘metal does not cure the disease of scoliosis, which is a condition involving much more than the spinal column’.
- the Harrington rods will either bend, break loose from the wires, or worse, break completely in two as the spine continues in its scoliotic path, necessitating further surgical intervention and removal of the rods. Once the rod is removed, corrosion (rust) is found on two out of every three patients. (56) After the operation is performed, the average patient suffers a 25% reduction in their spinal ranges of motion.
- There was as well not noted any improvement of pulmonary or cardiac function in the surgical group. Keep in mind that the non-fused adult scoliosis patients do not demonstrate this same impairment. This flatly contradicts the claim that having a steel, stainless steel rod fused to your spine will not affect your mobility, physical activities, or quality of life
HOUR 5
Conclusion
Conclusion
- The science is positioning chiropractic at the forefront in care for scoliosis, and perhaps other chronic conditions which have been linked to genetic predisposition. Science has also demonstrated that the conventional interventions offer poor outcomes with devastating and debilitating complications; further shinning the light on chiropractic as a primary choice of care as its side effects are negligible
- The most common side-effect of chiropractic scoliosis care reported in a medical study, who’s initial intent was to discourage chiropractic care for scoliosis, was muscle soreness (accounting for 35.2 % of all side effects). The next common most side-effects were neck pain (13.6 % of side effects), back pain (12.0 %), headache (10.6 %), stiffness (7.8 %), and discomfort from the adjusting instrument (7.1 %). Compare to allopathic problems.
- which include, the syndrome of inappropriate antidiuretic hormone, pancreatitis, superior mesenteric artery syndrome, ileus, pneumothorax, hemothorax, chylothorax, fat embolism, urinary tract infections, wound infection, hardware failure, and death.
- Chiropractic care has been found to be superior to bracing and possibly surgery. (65) This study found, ‘Chiropractic treatment was associated with a reduction in the degree of curvature of adolescent idiopathic scoliosis in this case, after half a year of conventional medical treatment had Asia-Pacific Chiropractic Journal Weiner & Blum, 6 failed to stop curve progression. This suggests that in at least some severe and progressive cases of scoliosis, chiropractic treatment including spinal manipulation may decrease the need for surgery.
- Vertebral Subluxation Complex has been made evident over and over again. Our 3 T’s (thoughts, toxins, trauma) have been validated and illustrated to affect even cellular and chromosomal changes. (67) The medical research has begun to discuss the phenomenon of subluxation, but by renaming it ‘dysponesis’ as not to lend any credibility to chiropractic. (68, 69) We now know that chiropractic can create profound changes in the body, not only neurological and structural, but epigenetic changes that will affect not only how our bodies function, but how the bodies of our children and our children’s children will function. Transgenerational genetic modifications
- Our goals
- challenge our profession to come forward and care for not only the patient in your office, but their children, families, and affect people for generations to come. Let us embrace how science of the 21st century is validating our chiropractic principles. We must throw off the self-imposed shackles of being narrowly defined as mechanical pain-based care and embrace our roots as health-based care. Like the enormous adult elephant, restrained by a thin rope and a small wooden peg in the ground. Held there in place only by the conditioning of the small pup not having the strength to free itself. The enormous adult elephant has learned not even to try to free himself, not even recognizing the power that it wields. Our power now comes from the science. There has been so much discussion of expanding our scope of practice. We should be concentrating on expanding our scope of demography.
- Therefore, from a conservative, effective, low risk perspective chiropractic care appears to be the primary consideration for scoliosis patients. Further study into this novel emerging field of care for scoliosis patients as well as the importance of chiropractic care for children and overall health for the general population is indicated.
| GIL WEINER, DC, LST, FFCLB |
Life Chiropractic College West has received programmatic accreditation through the Council on Chiropractic Education and institutional/regional accreditation through WASC Senior College and University Commission (WSCUC).
See below for a list of credits that may be available for this seminar.
*The following State and Province boards do not require an application when a program is sponsored by a college accredited by the Council on Chiropractic Education (CCE): CO, CT, DE, DC, ID, IL, IA, MD, MA, MI, MT, NE, NH, NJ, OR, RI, SC, UT, VT, VA, WA, WY, BC, NB, ON, QC. Life Chiropractic College West cannot guarantee that these licensing board(s) will accept any session of this offering. Life West urges licensees to familiarize themselves with the laws governing continuing education in the jurisdictions where they hold licensure.
Available Credit Hours
- 5.00 AK Chiropractic BoardAlaska Board of Chiropractic Examiners
- 5.00 BC Chiropractic CollegeBritish Columbia College of Chiropractors
- 5.00 CA Chiro Board, Category BCA Board of Chiropractic Examiners, Cat B
- 5.00 CO Chiropractic BoardColorado Board of Chiropractic Examiners
- 5.00 CT Chiropractic BoardConnecticut Board of Chiropractic Examiner
- 5.00 DC Chiropractic BoardDistrict of Columbia Board of Chiropractic
- 5.00 DE Chiropractic BoardDelaware Board of Chiropractic
- 5.00 GA Chiropractic BoardGeorgia Board of Chiropractic Examiners
- 5.00 IA Chiropractic BoardIowa Board of Chiropractic
- 5.00 ID Chiropractic BoardIdaho Board of Chiropractic Physicians
- 5.00 IL Chiropractic BoardIllinois Medical Licensing Board
- 5.00 IN Chiropractic BoardIndiana Board of Chiropractic Examiners
- 5.00 KS Chiropractic AssocKansas Chiropractic Association
- 5.00 KY Chiropractic BoardKentucky Board of Chiropractic Examiners
- 5.00 MA Chiropractic BoardMassachusetts Board of Registration of Chiropractors
- 5.00 MB Chiropractic AssocManitoba Chiropractors' Association
- 5.00 MD Chiropractic BoardMaryland Board of Chiropractic Examiners
- 5.00 ME Chiropractic BoardMaine Board of Chiropractic Licensure
- 5.00 MI Chiropractic BoardMichigan Board of Chiropractic
- 5.00 MN Chiropractic BoardMinnesota Board of Chiropractic Examiners
- 5.00 MO Chiropractic BoardMissouri Board of Chiropractic Examiners
- 5.00 MS Chiropractic BoardMississippi Board of Chiropractic Examiners
- 5.00 MT Chiropractic BoardMontana Board of Chiropractors
- 5.00 NB Chiropractic AssocNew Brunswick Chiropractors' Association
- 5.00 NC Chiropractic BoardNorth Carolina Board of Chiropractic Examiners
- 5.00 ND Chiropractic BoardNorth Dakota Board of Chiropractic Examiners
- 5.00 NE Chiropractic BoardNebraska Board of Chiropractic
- 5.00 NH Chiropractic BoardNew Hampshire Board of Chiropractic Examiners
- 5.00 NJ Chiropractic BoardNew Jersey Board of Chiropractic Examiners
- 5.00 NS Chiropractic CollegeNova Scotia College of Chiropractors
- 5.00 OH Chiropractic BoardOhio Chiropractic Board
- 5.00 OR Chiropractic BoardOregon Board of Chiropractic Examiners
- 5.00 PACEFCLB Providers of Approved Continuing Education
- 5.00 PR Chiropractic BoardPuerto Rico Board of Chiropractic Examiners
- 5.00 RI Chiropractic BoardRhode Island Board of Examiners in Chiropractic
- 5.00 SC Chiropractic BoardSouth Carolina Board of Chiropractic Examiners
- 5.00 SD Chiropractic BoardSouth Dakota Board of Chiropractic Examiners
- 5.00 TN Chiropractic BoardTennessee Board of Chiropractic Examiners
- 5.00 UT Chiropractic BoardUtah Chiropractic Physicians Licensing Board
- 5.00 VA Board of MedicineVirginia Board of Medicine
- 5.00 VI Chiropractic BoardU.S. Virgin Islands Board of Chiropractic Examiners
- 5.00 VT Chiropractic BoardVermont Board of Chiropractic
- 5.00 WA Chiropractic CommWashington Chiropractic Quality Assurance Commission
- 5.00 WY Chiropractic BoardWyoming Board of Chiropractic Examiners
Price
Cost:
$100.00
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