The Bottom Line

• There is no single nationwide system that regulates the credentials of complementary health professionals. Instead, individual states determine the specific qualifications required to practice.

• These requirements differ significantly depending on the state and the particular field of practice.

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

When visiting a healthcare provider, their credentials—such as diplomas and licenses—provide insight into their qualifications for offering guidance and care.

“Credentials” is a general term encompassing licenses, educational achievements, and certifications. Typically, government agencies issue licenses, while professional groups handle certification.

Certification may be required before obtaining a license or may act as a substitute in some cases. Becoming certified or licensed often entails fulfilling specified academic, training, or experience-based criteria. However, having a credential does not always equate to competence.

How States Credential Practitioners

• States credential complementary health professionals using several methods: Requiring full licenses to offer services, mandating license for title usage, or requiring practitioners to register training details with oversight agencies.

• Full licensure mandates that practitioners hold a license to legally deliver services.

• Title protection means only those with the right qualifications can use specific professional titles.

• Registration involves reporting background and training to a state consumer board.

• The process of obtaining a license varies—some states might require finishing an accredited education program, earning national certification, completing training hours, passing exams, and taking continuing education courses.

• Examples of licensure requirements include: graduation from an approved institution, national certification, hands-on training, assessment through exams, and ongoing education.

Each state also has its own regulations detailing which services are permitted. For instance, chiropractic practice laws differ widely across the country in the scope of services chiropractors can provide.

Education and Training

Many professional groups offer certifying exams to those who complete recognized training programs. Successful certification may help meet the qualifications for state licenses.

In the case of acupuncture, for example, most states require practitioners to be certified by a national body or to pass its exams before being approved for licensure. Certification groups include those for massage therapy, chiropractic, and naturopathic medicine.

Various training programs across the U.S. educate practitioners in complementary health fields. Some agencies within the federal government are authorized to officially recognize and accredit these programs. Examples include accrediting bodies for chiropractic and acupuncture.

Differences in Licensing Requirements for Complementary Health Practitioners

What practitioners are allowed to do and the process to acquire a license differs considerably based on their specialty and the state’s laws.

Examples of State Requirements for Specific Types of Practitioners

• All U.S. states and the District of Columbia require chiropractors to have a Doctor of Chiropractic degree from an approved institution and to pass either state-administered exams, national board exams, or both.

• Only a portion of U.S. states—17 plus the District of Columbia—license naturopathic doctors. Typically, a four-year degree from an accredited naturopathic medical school and passing a national board exam are required.

• Most states have established regulations for massage therapists, which may include licensing, registration, or certification. Many require at least 500 hours of approved training.

Credentialing Practitioners To Work in Integrative Health Settings

• A growing number of hospitals and integrative medical facilities offer complementary services. These institutions often establish their own rules to determine if a practitioner is qualified to work with them. These rules might require documentation of education and certification, background checks, continuing education credits, evidence of insurance, and experience in clinical or research environments.

NCCIH’s Role

The National Center for Complementary and Integrative Health (NCCIH) focuses on scientific research to explore the benefits, risks, and use of complementary health approaches. However, the NCCIH does not oversee licensing, training, or credentialing of individual practitioners.

If You’re Considering Going to a Complementary Health Practitioner

• Familiarize yourself with your state’s laws and qualification standards for complementary health professionals, including their limitations.

• Choose a provider of complementary care as carefully as you would any other healthcare provider.

• Stay fully involved in your well-being—always inform your health care providers about any complementary practices you’re using so your health decisions are informed and collaborative.

For More Information

NCCIH Clearinghouse

The Clearinghouse shares information about NCCIH’s work and complementary health therapies, including easy access to scientific literature. It does not offer medical advice or recommendations.

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

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

Email: [email protected]

Know the Science

NCCIH and the NIH provide resources aimed at helping the public better understand how scientific research works. These include videos, quizzes, and interactive tools to help clarify scientific language and research findings relating to health topics.

PubMed®

PubMed® is a database operated by the National Library of Medicine and provides summaries of research articles from medical journals. NCCIH also offers assistance for those seeking complementary health research information through PubMed®.

Key References

• Baynham-Fletcher L, Babiak-Vazquez AE, Cuello D, et al. Credentialing complementary practitioners in a large academic cancer center. Journal of the Society for Integrative Oncology. 2008;6(4):169–175.

• Chang M. The chiropractic scope of practice in the United States: a cross-sectional survey. Journal of Manipulative and Physiological Therapeutics. 2014;37(6):363–376.

• Cohen MH, Nelson H. Licensure of complementary and alternative practitioners. Virtual Mentor: AMA Journal of Ethics. 2011;13(6):374–378.

• Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965–973.

• Hayes M, Muhota J, Nguyen L, et al. A framework for credentialing naturopathic physicians in academic health centers. Journal of Alternative and Complementary Medicine. 2014;20(3):217–218.

• Nedrow A. Status of credentialing alternative providers within a subset of U.S. academic health centers. Journal of Alternative and Complementary Medicine. 2006;12(3):329–335.

• Stumpf SH, Hardy ML, McCuaig S, et al. Acupuncture practice acts: a profession’s growing pains. Explore. 2015;11(3):217–221.

This content is in the public domain and may be freely reproduced. NCCIH offers this information as an educational resource. It does not replace professional medical advice or care. Mention of any specific service or therapy does not imply endorsement by NCCIH.