How to start a chiropractic business from the ground up

Starting a chiropractic business is a rewarding venture that combines your passion for patient care with sharp business savvy. The industry is worth billions, driven by consistent demand for chiropractic care from athletes, office workers, and those recovering from accidents.

This guide will take you through the practical steps of obtaining licenses, securing funding, selecting the right location, and acquiring equipment to help you launch a successful chiropractic business in the U.S.

Step 1: Create your business plan and research the market

First, you will want to validate your practice idea. Use U.S. Census Bureau data to analyze neighborhood demographics. Reports from the American Chiropractic Association can also provide great insight into patient trends and service demands in your region.

Analyze your local competition

Map out all chiropractic clinics within a five-mile radius using Google Maps. Review their websites to understand their services, specialties, and patient reviews. A frequent oversight is to ignore physical therapy clinics or wellness centers that also attract your target patients.

Estimate your startup costs

Your initial investment will depend on your location and equipment choices. A thoughtful budget prevents financial strain later. Many new owners make the mistake of buying expensive equipment at the start. You might consider leasing high-cost items or buying refurbished gear to manage your initial outlay.

• Equipment (tables, diagnostic tools): $20,000 - $70,000
• Lease deposit and renovation: $10,000 - $50,000
• Licensing, insurance, and legal fees: $3,000 - $8,000
• Practice management software: $1,000 - $4,000 annually
• Initial marketing budget: $3,000 - $7,000

Here are 3 immediate steps to take:

• Draft a one-page business summary that outlines your target patient and unique services.
• Create a spreadsheet of local competitors, noting their services and online presence.
• Build a detailed startup budget with low and high estimates for each cost category.

Step 2: Set up your legal structure and secure licenses

Your first legal task is to choose a business structure. Most new chiropractors form a Limited Liability Company (LLC) because it separates your personal assets from business debts. This provides important liability protection that a sole proprietorship does not.

An LLC also offers pass-through taxation. You might also elect for S Corp status to potentially lower self-employment taxes. A quick consultation with a CPA can clarify the best path for your financial situation. Many new owners skip this, which can lead to tax headaches later.

Licensing and permits

With your business entity registered, you can focus on licensing. Your main credential is the Doctor of Chiropractic (D.C.) license, issued by your state's board of chiropractic examiners. The application requires your National Board of Chiropractic Examiners (NBCE) exam scores and can take 2-4 months to process.

You will also need a general business license from your city or county, which typically costs $50 to $400. Before opening, you must also obtain a Certificate of Occupancy for your clinic to confirm it meets all zoning and safety codes.

Here are 3 immediate steps to take:

• Consult a CPA to decide between an LLC and an S Corp structure.
• Visit your state's board of chiropractic examiners website to start the D.C. license application.
• Contact your city clerk’s office to get forms for a business license and Certificate of Occupancy.

Step 3: Secure your insurance and manage risk

Protecting your practice from day one requires several specific types of insurance. Your most important policy is professional liability, also known as malpractice insurance. This covers you if a patient claims they were injured during treatment.

Types of coverage you will need

You will want to bundle a few policies together for complete protection. Many new owners underestimate their liability and select policies with low coverage limits, which can be a costly mistake if a claim arises.

• Professional Liability: A standard policy provides $1 million per incident and a $3 million annual aggregate limit.
• General Liability: This covers non-treatment accidents, like a patient who slips and falls in your waiting room.
• Property Insurance: Protects your expensive equipment, furniture, and tenant improvements from fire or theft.
• Workers’ Compensation: This is mandatory in most states as soon as you hire your first employee.

Expect to pay between $2,000 and $5,000 annually for a comprehensive package. You might consider providers that specialize in chiropractic care, such as NCMIC, ChiroSecure, or HPSO. They understand the industry's unique risks and often offer better rates than general carriers.

Here are 3 immediate steps to take:

• Request quotes from at least two chiropractic-specific insurers like NCMIC or ChiroSecure.
• Ask potential providers about policies that bundle professional and general liability coverage.
• Confirm your state's workers' compensation requirements if you plan to hire staff.

Step 4: Find your location and buy equipment

Look for a clinical space between 1,200 and 1,500 square feet. This size comfortably fits a reception area, two treatment rooms, an office, and a restroom. Confirm the property has commercial or medical office zoning with your local planning department before you sign anything.

Select your core equipment

Your adjustment table is the main purchase. While new tables cost $2,000 to $15,000, you can find quality refurbished options for much less. Many new practice owners make the mistake of buying all new equipment, which can strain the initial budget unnecessarily.

• Chiropractic adjustment table: $2,000 - $15,000
• X-ray machine (optional): $30,000 - $60,000 (leasing is a popular alternative)
• Reception furniture and office supplies: $2,000 - $7,000

You can source equipment from industry suppliers like MeyerDC or ScripHessco. They often have packages for new practices.

Negotiate your clinic lease

When you discuss lease terms, ask for a Tenant Improvement (TI) allowance. This is a sum the landlord provides to help you build out the space for treatment rooms. A frequent oversight is to sign a long-term lease without an exit clause. Negotiate for a shorter term or a break option.

Here are 3 immediate steps to take:

• Contact a commercial real estate agent who has experience with medical office leases.
• Request quotes for both new and refurbished adjustment tables from two different suppliers.
• Ask potential landlords about their standard Tenant Improvement allowance for new tenants.

Step 5: Set up your payment processing

Most chiropractors offer pay-per-visit options and prepaid packages for a series of treatments. You will want a payment system that can handle both. Many new owners get locked into processors with high monthly fees or clunky hardware, which can eat into your profits early on.

Choose your payment solution

Look for a solution with transparent, low transaction rates and no long-term contracts. For practices that need to accept payments on-site or on-the-go, JIM offers a streamlined solution. You can accept debit, credit, and digital wallets directly through your smartphone.

At just 1.99% per transaction with no hidden costs or extra hardware, it is a great fit for taking payment after an adjustment or for selling wellness products. This rate is significantly lower than the 2.5% to 3.5% average commission other providers often charge.

Getting started is straightforward:

• Get Started: Download the JIM app for iOS.
• Make a Sale: Type the sales amount, hit sell, and ask your customer to tap their card or device on your phone.
• Access Funds: Your money is available on your JIM card as soon as the sale is done, with no waiting for bank transfers.

Here are 3 immediate steps to take:

• Decide on your payment model, such as pay-per-visit or discounted treatment packages.
• Download the JIM app to see how it works on your phone.
• Calculate the potential savings from JIM's 1.99% rate versus the industry average.

Step 6: Secure funding and manage your finances

Most new chiropractors secure an SBA 7(a) loan, which can range from $50,000 to $250,000. Lenders typically look for a credit score above 680 and a well-researched business plan. While industry-specific grants are rare, your local Small Business Development Center (SBDC) can help you find them.

Estimate your working capital

Plan to have six months of operating costs in the bank. This working capital, usually between $40,000 and $75,000, covers rent, insurance, and marketing before patient flow is steady. Many new owners underestimate this and face a cash crunch within their first year.

You might also consider these funding options:

• Conventional Bank Loans: These may offer slightly lower interest rates, around 7-10%, but often require collateral and a stronger financial history.
• Equipment Financing: This is a separate loan used specifically to purchase or lease your adjustment tables and diagnostic tools.

Here are 3 immediate steps to take:

• Check your credit score and download your full credit report to identify any issues.
• Contact your local SBDC for free assistance with your SBA loan application.
• Create a detailed six-month operating budget to calculate your exact working capital needs.

Step 7: Hire your team and set up operations

Your first hire is usually a Chiropractic Assistant. This person manages the front desk, schedules appointments, and handles billing. Many new owners focus too much on prior experience and overlook a candidate's personality. You want someone who makes patients feel welcome from the moment they call.

Expect to pay a salary between $35,000 and $50,000 annually. While not always required, a Certified Chiropractic Professional Assistant (CCPA) certification shows a candidate has specialized training. This can be a valuable asset for your practice.

Choose your practice management software

With a team member in place, you need a system to manage operations. Look at practice management software like Jane App or ChiroFusion. These platforms combine scheduling, electronic health records (EHR), and billing into one place, which simplifies your daily workflow.

As your practice grows, aim to keep total staff costs between 15% and 25% of your gross revenue. This is a healthy benchmark for a solo practitioner's clinic and helps you decide when it is time to hire more help.

Here are 3 immediate steps to take:

• Draft a job description for a Chiropractic Assistant that emphasizes patient service skills.
• Request demos for two practice management systems, such as Jane App and ChiroFusion.
• Calculate your target staff budget using your first-year revenue projections.

Step 8: Market your practice and get patients

Your first marketing goal is to dominate local search. Set up and verify your Google Business Profile immediately. This is how patients find you on Google Maps. Actively encourage your first few patients to leave reviews to build credibility quickly.

Build a referral network

Connect with local family doctors, physical therapists, and personal injury lawyers. A simple introductory letter followed by a coffee meeting can create a steady stream of patient referrals. This direct approach often yields better results than expensive digital ads.

Many new owners spend heavily on paid ads right away. You should aim for a patient acquisition cost (CAC) below $150. Referral networks and local SEO are the most cost-effective ways to achieve this in your first year of operation.

Engage with the community

Offer free posture workshops at local gyms or corporate offices. This positions you as an expert and generates leads. A 30-minute talk can easily bring in two to five new patient consultations, which makes it a high-return activity for your time.

Here are 3 immediate steps to take:

• Create and fully populate your Google Business Profile with photos and service details.
• Draft an introductory letter to send to five local doctors or physical therapists.
• Outline a 30-minute posture workshop to present at a local business or gym.

Step 9: Set your pricing and service menu

Your pricing strategy should balance market rates with your revenue goals. Most chiropractors use a pay-per-visit model for acute issues and discounted packages for ongoing care. A standard adjustment typically costs between $65 and $95, depending on your market.

Define your service offerings

Start by calling at least three local competitors to ask for their cash price for a new patient exam and a standard adjustment. This gives you a clear baseline. Many new owners underprice their services to attract patients, but this can signal a lack of confidence and devalue your expertise.

A better approach is to price competitively and create value through packages. For example, if your single adjustment is $85, you might offer a 12-visit package for $900. This lowers the per-visit cost to $75, encourages patient commitment, and secures your revenue upfront.

Your prices must cover your operating expenses and provide a healthy profit. A solo practice should aim for a gross profit margin of 60% to 70% on services to ensure financial stability and growth. This margin helps you absorb slow months and reinvest in the business.

Here are 3 immediate steps to take:

• Create a simple service menu with prices for a single visit and at least one multi-visit package.
• Calculate your break-even point by dividing monthly costs by your average price per visit.
• Set a first-year gross revenue target based on your market research and financial needs.

Step 10: Measure quality and scale your practice

To maintain high standards, track your Patient Visit Average (PVA). A healthy practice often sees a PVA between 12 and 15. You should also monitor your patient retention rate, with a goal to keep at least 80% of new patients beyond their initial care plan.

You can measure patient satisfaction with a Net Promoter Score (NPS) survey. A simple one-question email asks how likely patients are to recommend you. This provides direct feedback on your service quality and patient experience.

Plan your growth

Once you are consistently booked at 80% capacity for two months, it is time to hire another chiropractor. A frequent misstep is to wait too long, which can lead to burnout and a decline in care quality. This capacity benchmark is a clear signal of healthy demand.

When your clinic operates near 85% capacity with a larger team, you can explore expansion. This could mean adding a treatment room or finding a bigger space. Your practice management software, like Jane App or ChiroFusion, will help manage schedules for a growing team.

Here are 3 immediate steps to take:

• Calculate your Patient Visit Average and retention rate from the last quarter.
• Set a capacity alert in your calendar for when you hit 80% booking for a full week.
• Draft a one-question NPS survey to send to your 20 most recent patients.

You now have the roadmap to open your chiropractic clinic. Remember, your success depends as much on sharp business operations as it does on patient care. Follow these steps with confidence, and you will build a practice that lasts.

A lasting practice also needs smooth payments. JIM lets you accept cards on your phone for a simple 1.99% fee, without extra hardware. It keeps your cash flow healthy from day one. Download JIM and simplify your checkout.