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Credentialing, Licensing, and Education

credentialing_Chiropractic_23_by Matthew Lester

The Bottom Line

  • There is no standardized national system for credentialing complementary health practitioners. State governments are responsible for deciding what credentials practitioners must have to work in that state.
  • The credentials required for complementary health practitioners vary widely from state to state and from discipline to discipline.

Credentials, Licenses, Certification—What’s the Difference?

Health care providers’ credentials—the licenses, certificates, and diplomas on their office walls—tell us about their professional qualifications to advise and treat us.

Credentials is a broad term that can refer to a practitioner’s license, certification, or education. In the United States, government agencies grant and monitor licenses; professional organizations certify practitioners.

Certification can be either a prerequisite for licensure or, in some cases, an alternative. To get certified or licensed, practitioners must meet specific education, training, or practice standards. Being licensed or certified is not always a guarantee of being qualified.

How States Credential Practitioners

  • States use the following approaches to credential practitioners:
    • Mandatory licensure: requires practitioners to have a license for providing a service.
    • Title licensure: requires practitioners to have credentials before using a professional title.
    • Registration: requires practitioners to provide information about their training and experience to a state consumer protection agency.
  • States’ requirements for granting a license vary considerably. They may require those seeking a license to do one or more of the following:
    • Graduate from an approved program.
    • Meet certification requirements of a national organization.
    • Complete a specified amount of training.
    • Pass an exam.
    • Participate in continuing education.

State laws vary widely in the services they allow complementary health practitioners to offer. For example, a national survey of laws governing chiropractic showed substantial differences among states in the number of services and practices that chiropractors are allowed to perform.

Education and Training

Professional organizations in some complementary health professions offer certification examinations to graduates of accredited education and training programs. Certification may play a role in qualifying graduates for state licensure.

For example, in most states acupuncturists must be certified by the National Certification Commission for Acupuncture and Oriental Medicine or pass that organization’s exams to be licensed. Some of the other professional organizations involved in certification include the National Certification Board for Therapeutic Massage & Bodywork, the National Board of Chiropractic Examiners (NBCE), and the North American Board of Naturopathic Examiners.

Schools and educational programs across the country train complementary health practitioners and prepare them for certification in their field. The U.S. Department of Education authorizes specific organizations to accredit education or training programs. For example, it has authorized The Council on Chiropractic Education to accredit chiropractic colleges and the Accreditation Commission for Acupuncture and Oriental Medicine to accredit acupuncture programs.

Differences in Licensing Requirements for Complementary Health Practitioners

The requirements for treating patients vary considerably from state to state and among the different practices.

Examples of State Requirements for Specific Types of Practitioners

  • In all 50 states and the District of Columbia, chiropractors must be an accredited Doctor of Chiropractic (D.C.) and must pass special state exams, exams administered by the NBCE, or both.
  • Only 17 states and the District of Columbia license naturopathic physicians. In general, licensure requires graduating from an accredited 4-year school of naturopathic medicine and passing a postdoctoral board examination.
  • Most states regulate massage therapists by requiring a license, certification, or registration. Training standards and requirements vary by state, but most states that regulate massage therapists require a minimum of 500 hours of training.

Credentialing Practitioners To Work in Integrative Health Settings

  • Complementary health services are increasingly being provided within hospitals or integrative care settings. Some health care organizations are developing and standardizing their procedures for deciding which practitioners are qualified to work for them. Requirements may include establishing competency (such as proof of training), licensure or certification, background checks, continuing education hours, proof of malpractice insurance coverage, and experience working in the field or specifically in a hospital or research setting.

NCCIH’s Role

The mission of the National Center for Complementary and Integrative Health (NCCIH) is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health approaches and their roles in improving health and health care. NCCIH is not involved in the clinical training, credentialing, or licensing of complementary health practitioners.

If You’re Considering Going to a Complementary Health Practitioner

  • Understand your state government’s requirements for licensing and certification of practitioners, and the limitations of those requirements.
  • Select a complementary practitioner with the same care you would use in choosing a conventional medical provider.
  • Take charge of your health—talk with your health care providers about any complementary approaches you use. Together, you can make shared, well-informed decisions.

For more information on selecting a practitioner, see NCCIH’s tips on Selecting a Complementary Health Practitioner.

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1


Email: (link sends email)

Know the Science

NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. Know the Science features a variety of materials, including interactive modules, quizzes, and videos, as well as links to informative content from Federal resources designed to help consumers make sense of health information.

Explaining How Research Works (NIH)

Know the Science: How To Make Sense of a Scientific Journal Article

Understanding Clinical Studies (NIH)


A service of the National Library of Medicine, PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals. For guidance from NCCIH on using PubMed, see How To Find Information About Complementary Health Approaches on PubMed.


Key References

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Last Updated: May 2018