The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Rules
BILL: CS/CS/SB 1474
INTRODUCER: Rules Committee; Health Policy Committee; and Senator Trumbull
SUBJECT: Chiropractic Medicine
DATE: February 27, 2024 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Brown HP Fav/CS
Winkle
2. Rossitto-Van
Twogood RC Fav/CS
Winkle
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/SB 1474 expands the scope of practice for chiropractic physicians to treat the human
body through the use of monofilament intramuscular stimulation, also known as dry needling, for
trigger points or myofascial pain.
The bill requires the BCM to establish minimum practice standards and education requirements
by which a chiropractic physician may perform dry needling on patients, within the scope of the
practice of chiropractic medicine.
The bill creates exceptions to the dry needling practice standards and education requirements by
authorizing the BCM to waive some or all of the educational requirements if a chiropractor
presents satisfactory proof of having completed coursework that constitutes adequate training for
dry needling.
The bill also gives the BCM the authority to recognize chiropractic physician applicants for
licensure if they provide a credential evaluation report from a board-approved organization that
deems the applicant’s education equivalent to a bachelor’s degree from a college or university
accredited by an institutional accrediting agency recognized and approved by the U.S.
Department of Education. The effect of this change is to create a licensure pathway for
chiropractic physicians to practice in Florida when they obtained their bachelor’s degree at a
non-U.S. educational institution of higher education.
 BILL: CS/CS/SB 1474 Page 2
The bill provides an effective date of July 1, 2024.
II. Present Situation:
The Practice of Chiropractic Medicine
The BCM, in conjunction with the Department of Health (DOH), regulates the practice of
chiropractic medicine pursuant to chs. 456 and 460, F.S.
Florida law defines the practice of chiropractic medicine as a noncombative principle and
practice consisting of the science, philosophy, and art of the adjustment, manipulation, and
treatment of the human body in which vertebral subluxations and other malpositioned
articulations and structures that are interfering with the normal generation, transmission, and
expression of nerve impulses between the brain, organs, and tissue cells of the body, thereby
causing disease, are adjusted, manipulated, or treated, thus restoring the normal flow of nerve
impulse which produces normal function and consequent health by chiropractic physicians using
specific chiropractic adjustment or manipulation techniques taught in chiropractic colleges
accredited by the Council on Chiropractic Education (CCE).1
Licensed chiropractic physicians may examine, analyze, and diagnose the human living body and
its diseases by the use of:2
 Any physical, chemical, electrical, or thermal method;
 X-ray for diagnosing;
 Phlebotomizing; and
 Any other general method of examination for diagnosis and analysis taught in any school of
chiropractic.
Chiropractic physicians may adjust, manipulate, or treat the human body by:3
 Manual, mechanical, electrical, or natural methods;
 The use of physical means or physiotherapy, including light, heat, water, or exercise;
 The use of acupuncture, if certified;
 The administration of foods, food concentrates, food extracts, and items for which a
prescription is not required and may apply first aid and hygiene;
 Analyze and diagnose abnormal bodily functions and to adjust the physical representative of
the primary cause of disease;
 Caring for the sick and advising and instructing patients in all matters pertaining to hygiene
and sanitary measures as taught and approved by recognized chiropractic schools and
colleges.
Chiropractic physicians are expressly prohibited from:4
1
Section 460.403(9)(a), F.S.
2
Section 460.403(9)(b), F.S.
3
Section 460.403(9)(c)(f), F.S.
4
Id.
BILL: CS/CS/SB 1474 Page 3
 Ordering, storing, or administering to any person any legend drug, except medical oxygen for
emergency purposes only at the chiropractic physician’s office or place of business, and the
following topical aesthetics in aerosol form:
o Any solution consisting of 25 percent ethylchloride and 75 percent
dichlorodifluoromethane; and
o Any solution consisting of 15 percent dichlorodifluoromethane and 85 percent
trichloromonofluoromethane.
 Performing any surgery except as otherwise provided in the practice act;
 Practicing obstetrics;
 Using diagnostic or treatment instruments the use of which are not taught in the regular
course of instruction in a college recognized by the Board of Chiropractic;5
 Treating Cancer, Leukemia, Tuberculosis, Syphilis, Gonorrhea, Hepatitis, Anthrax,
Diphtheria, Hansen’s Disease, Hookworm Disease, Malaria, Rabies, Typhoid Fever, and
AIDS.6
The Board of Chiropractic Medicine
The BCM is created within the DOH and consist of seven members, appointed by the Governor
and confirmed by the Senate. Five members must be licensed chiropractic physicians who are
residents of the state and who have been licensed chiropractic physicians engaged in the practice
of chiropractic medicine for at least four years. The remaining two members must be residents of
the state who are not, and have never been, licensed chiropractic physicians or members of any
closely related profession. At least one member of the board must be 60 years of age or older. As
the terms of the members expire, the Governor appoint successors for terms of four years, and
such members must serve until their successors are appointed.7
Chiropractic Education
The National Board of Chiropractic Examiners
The National Board of Chiropractic Examiners (NBCE), including the International Board of
Chiropractic Examiners (IBCE), is the international testing agency for the chiropractic
profession. The NBCE develops, administers and scores standardized exams that assess
knowledge, higher-level cognitive abilities and problem-solving in various basic science and
clinical science subjects.8
The purpose of the NBCE is to establish and maintain uniform high standards of excellence in
the chiropractic profession and chiropractic education, primarily but not exclusively by preparing
and administering to qualified applicants examinations of superior quality, whereby those legal
agencies which govern the practice of chiropractic within each state and other countries may
accept, at their discretion, those individuals who have successfully completed any part of the
examinations of the NBCE, and by providing test and measurement services to the chiropractic
5
Fla. Admin. Code R. 64B2-17.001 (2023).
6
Fla. Admin. Code R. 64B2-17.002 (2023).
7
Section 460.404, F.S.
8
National Board of Chiropractic Examiners, About the NBCE, available at https://www.nbce.org/about-nbce/ (last visited
Feb. 1, 2024).
BILL: CS/CS/SB 1474 Page 4
profession in all areas of demonstrated need, and to advance the chiropractic profession when in
the best interests of the corporation and chiropractic testing.9
In addition, chiropractors may earn post-doctoral diplomate certifications from the International
Chiropractors Association as well as various subspecialties, such as acupuncture, radiology, and
neurology, through the American Chiropractic Association. Certifications are also available in
veterinary chiropractic, spinal trauma, sport science and other niche disciplines.10
In the U.S., there are 15 NBCE-accredited chiropractic colleges and universities on 18
campuses:11
 Campbellsville University School of Chiropractic in Harrodsburg, Kentucky;
 Cleveland Chiropractic College in Overland Park, Kansas;
 D’Youville College in Buffalo, New York;
 Keiser University in West Palm Beach, Florida;
 Life University, College of Chiropractic in Marietta, Georgia, and Hayward, California;
 National University of Health Sciences in Seminole, Florida;
 Northeast College of Health Sciences in Seneca Falls, New York;
 Northwestern Health Sciences University in Bloomington, Minnesota;
 Palmer College of Chiropractic in Port Orange, Florida, and San Jose, California;
 Parker College of Chiropractic in Dallas, Texas;
 Sherman College of Chiropractic in Spartanburg, South Carolina;
 Southern California University of Health Sciences in Whittier, California;
 Texas Chiropractic College in Pasadena, Texas;
 University of Bridgeport, School of Chiropractic in Bridgeport, Connecticut;
 University of Western States in Portland, Oregon.
To earn and maintain accreditation, chiropractic colleges must meet a variety of requirements.
Each program’s curriculum must include at least 4,200 instructional hours of course credits.
Once a student is accepted into an accredited program, chiropractic students typically follow a
curriculum similar to the following:12
 First year
o General anatomy;
o Histology;
o Chiropractic principles;
o Palpation;
o Human physiology;
o Chiropractic procedures;
o Embryology;
o Introduction to physical examination;
o Human biochemistry;
9
Id.
10
National Board of Chiropractic Examiners, Certification and Licensure, available at https://www.nbce.org/about-
nbce/chiropractic-care/certification-and-licensure/ (last visited Feb. 1, 2024).
11
National Board of Chiropractic Examiners, Links to Chiropractic Colleges, available at https://www.nbce.org/links-to-
chiropractic-colleges/ (last visited Feb. 1, 2024).
12
National Board of Chiropractic Examiners, Chiropractic Education, available at https://www.nbce.org/about-
nbce/chiropractic-care/chiropractic-education/ (last visited Feb. 1, 2024).
BILL: CS/CS/SB 1474 Page 5
o Clinical chiropractic;
o Neuroanatomy and neurophysiology;
o Normal radiographic anatomy;
o Fundamentals of nutrition;
o Functional anatomy/biomechanics; and
o Spinal anatomy.
 Second year
o Pharmatoxicology;
o Pathology;
o Chiropractic procedures;
o Clinical orthopedics and neurology;
o Community and public health;
o Clinical nutrition;
o Practice management;
o Differential diagnosis;
o Emergency care;
o Clinical microbiology;
o Chiropractic principles;
o Physics of clinical imaging;
o Nutritional assessment;
o Physiological therapeutics;
o Research methods;
o Imaging interpretation; and
o Applied clinical chiropractic.
 Third year
o Integrated chiropractic clinical application;
o Chiropractic principles;
o Radiologic positioning and technique;
o Clinical application of manual procedures;
o Clinical internship;
o Clinical psychology;
o Pediatrics;
o Clinical laboratory clerkship;
o Original research project;
o Physiological therapeutics;
o Practice management;
o Diagnostic imaging interpretation;
o Differential diagnosis;
o Dermatology;
o Obstetrics and gynecology;
o Geriatrics; and
o Ethics and jurisprudence.
In the fourth year of chiropractic college, students work a clinical internship in a chiropractor’s
office. In addition to treating patients under the supervision of an experienced chiropractor, many
students also complete a clinical rotation at a hospital or veterans clinic.
BILL: CS/CS/SB 1474 Page 6
Chiropractic Licensure by Examination
Any person desiring to be licensed as a chiropractic physician in Florida must apply to the DOH
to take the licensure examination. The nonrefundable application fee is capped at $100, and the
NBCE administers the examination. The examination fee must not exceed $500 plus the actual
per applicant cost to the DOH for purchase of portions of the examination from NBCE.13
The DOH examines each applicant whom the BCM certifies has met all of the following
criteria:14
 Completed the application form and remitted the appropriate fee;
 Submitted proof that the applicant is 18 years of age or older;
 Submitted proof that the applicant is a graduate of a chiropractic college which is accredited
by CCE or its predecessor agency;
 Successfully completed the NBCE certification examination in parts I, II, III, and IV, and the
physiotherapy examination of the NBCE and the NBCE Physiotherapy Examination with a
score 375 on each section;15
 Successfully completed the NBCE Florida Laws and Rules examination with a score of 75
percent;16
 Submitted to the DOH a set of fingerprints on a form specified by the DOH and the fee for
the criminal background check of the applicant.
For an applicant who has matriculated in a chiropractic college before July 2, 1990, to take the
NBCE certification examination, he or she must have completed at least two years of residence
college work, consisting of a minimum of one-half the work acceptable for a bachelor’s degree
granted on the basis of a 4-year period of study, in a college or university accredited by an
institutional accrediting agency recognized and approved by the U.S. Department of Education
(DOE).17
For an applicant who has matriculated in a chiropractic college after July 1, 1990, to take the
NBCE certification examination, he or she must have: 18
 Been granted a bachelor’s degree, based upon four academic years of study, by a college or
university accredited by an institutional accrediting agency that is a member of the
Commission on Recognition of Postsecondary Accreditation;
 Effective July 1, 2000, completed, before matriculation in a chiropractic college, at least
three years of residence college work, consisting of a minimum of 90 semester hours leading
to a bachelor’s degree in a liberal arts college or university accredited by an institutional
accrediting agency recognized and approved by the U.S. DOE;
 Been granted a bachelor’s degree from an institution holding accreditation for that degree
from an institutional accrediting agency that is recognized by the U.S. DOE. The applicant’s
chiropractic degree must consist of credits earned in the chiropractic program and may not
include academic credit for courses from the bachelor’s degree.
13 Section 460.406(1), F.S.
14 Section 460.406(1), F.S.
15
Fla. Admin. Code R. 64B2-11.001(2023).
16
Id.
17
Section 460.406(1)(d)1., F.S.
18
Section 460.406(1)(d)2., F.S.
BILL: CS/CS/SB 1474 Page 7
The above matriculation requirements for applicants to have a bachelor’s degree from a school
accredited by an agency recognized and approved by the U.S. DOE may prevent persons who
have obtained their bachelor’s degree at a non-U.S. educational institution of higher education
from being considered for licensure in Florida, even if they graduated from a U.S. chiropractic
college or university.