Biennial Chiropractic License Renewal
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4CHI
Department of Community and Economic Development
Division of Occupational Licensing
P.O. Box 110806
Juneau, Alaska 99811-0806
(907) 465-2589
E-mail: license@dced.state.ak.us
BIENNIAL CHIROPRACTIC LICENSE RENEWAL
January 1, 2001 - December 31, 2002
Name:
License Number:
IT IS TIME TO RENEW YOUR CHIROPRACTIC LICENSE
Your license to practice as a chiropractor in the State of Alaska expires on December 31, 2000. It is illegal for you to practice if your license
has expired. THERE IS NO GRACE PERIOD. To renew your license for the period January 1, 2001, through December 31, 2002, return this
completed and signed application to the above address with a check or money order payable to the State of Alaska. This is the only renewal notice
you will receive. Incomplete applications or insufficient fees will result in your renewal being rejected.
RENEWAL DUE DATE
The processing time for correct and complete renewal applications is three to four weeks. Submit this renewal
application on or before November 30, 2000, to ensure processing prior to December 31, 2000.
NAME CHANGE
If you have had a legal name change since your last license was issued, enclose a certified true copy of the
legal document (marriage certificate, divorce decree, etc.) as proof of the change.
EXPIRED LICENSES
If you choose not to renew your license before it expires, you may renew the license at a later date only after
satisfying the requirements of 12 AAC 16.390. Licenses which have expired more than five years cannot
be renewed.
INACTIVE STATUS
In accordance with AS 08.20.165, if you do not practice in the state, you may convert your license to inactive
status. To renew in an inactive status, you must meet the same renewal requirements applicable to
renewing an active license. If you practice in the state, however infrequently, you must hold an active
license.
RETIRED STATUS
In accordance with AS 08.20.167, if you have retired and hold a license in good standing, you may convert
your license to a retired status license. To renew in a retired status, you are exempt from continuing
education requirements. A person holding a retired status license may not practice in the state.
SOCIAL SECURITY NUMBERS
In accordance with AS 08.01.060(b), the department is not authorized to renew a license unless the
applicant's social security number has been provided to the department. If you previously qualified for a
waiver, you must requalify for each renewal. Contact the division for a waiver application.
PAYMENT OF CHILD SUPPORT
If the Alaska Commission on Postsecondary Education has determined you are in loan default, or if the
AND STUDENT LOANS
Alaska Child Support Enforcement Division has determined you are in arrears on child support, you will be
issued a nonrenewable, temporary license valid for 150 days. Contact Postsecondary Education at
(888) 441-2961 or (907) 465-2961 or Child Support Enforcement at (800) 478-3300 or (907) 269-6659 to
resolve payment issues.
PUBLIC INFORMATION
Please be aware that all information on this renewal form will be available to the public, unless required to
be kept confidential by state or federal law.
BUSINESS LICENSES
Renewal applications for business licenses will be mailed separately. For more information about business
licenses, call (907) 465-2550, or access the website:
CONTINUING EDUCATION
Your license cannot be renewed unless you have met the continuing education requirements in 12 AAC
16.290. (See enclosed regulations on page 5 and 6.) You may wish to access the listing of approved
continuing education courses through our website:
Licenses #001 through 341 must have completed at least 24 hours of approved continuing education, at
least one-third and no more than one-half must be in x-ray or diagnostic imaging.
Licenses #342 through 354 must have completed at least 12 hours of approved continuing education, at
least one-third and no more than one-half must be in x-ray or diagnostic imaging.
Licenses #355 and above do not need to document continuing education for this renewal only.
RANDOM AUDIT
In accordance with 12 AAC 02.960, the Alaska Board of Chiropractic Examiners will audit a percentage of
the license renewals. If your renewal is randomly selected for audit, you will be notified and required to
submit documentation to verify completion of the continuing education requirements as stated on this
renewal form. You must save your documents for at least four years so you can respond to audits.
08-0094 (Rev. 10/00)
CONTINUED ON REVERSE SIDE
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