Part IV

What Is Part IV

DIM consists of 20 stations which are allotted two minutes per station. During the DIM portion, you will be viewing diagnostic images on a monitor and answering two questions related to the images.

Chiropractic Technique consists of five stations with five minutes allotted to complete each station. During the Chiropractic Technique portion, you will be required to read instructions and set up for spinal and extremity adjustments.

The NBCE Part IV exam consists of three major sections and each of the sections is divided into stations.

The Three Sections Are:

  • Diagnostic Imaging (DIM)
  • Chiropractic Technique
  • Case Management

Case Management consists of 20 stations with five minutes allotted to complete each station. You will be asked to perform a case history, physical examination, orthopedic, or neurological test. Following each patient encounter, you will be asked to answer two extended multiple choice questions.

The Chiropractic Technique section and the Case Management sections are given together and require approximately two hours and 45 minutes of testing time, but may require an additional five hours of sequestration in a building.

Who Can Take Part IV?

  • You are eligible to apply for Part IV if you have passed all subjects of Part I.
  • You must also be within six months of graduation or a graduate of an eligible chiropractic college.
  • See additional eligibility requirements if you have graduated, or are retaking Part IV.


What Topics Are Included In Part IV?

The NBCE develops every exam based on a test plan. The detailed Part IV Test Plan includes detailed descriptions of each section of the Part IV Exam.


Test Sites and Test Site Rules

The NBCE offers Part IV at chiropractic colleges across the country. You can select a test site when you apply. See the complete List of Test Sites.

Effective with the May 2022 Part IV administration, Life Chiropractic College West – Hayward, CA, is an available Part IV test site option.

If you would like to choose Life West as one of your site preferences and have already completed your application, you can still make site preference changes in your application at any time as long as it is prior to the February 17 application deadline. Please be sure to click SAVE once you have made your site preference selections.  Site assignments will be assigned within two weeks after the deadline and are assigned first come, first served, based on your payment date and time. Therefore, changing your test site preferences does not impact the priority of your application. Please contact with any questions you may have.

The only items you will be allowed to bring into the testing area are one form of identification, your food and beverage items, packaged in clear plastic bags, and a key to your car. Please review the complete list of Test Site Rules before you arrive to take your test.

Exam Administration Dates

2022 Dates & Deadlines (PDF)

The next Part IV exam is scheduled each May and November. Approximately eight weeks before the exam, the NBCE will post a confirmation that includes your testing schedule. Look for this on your MyNBCE account under My Exams, Exams then scroll down to the Part IV application.

Administration Dates Application Deadline Exams Offered
May 14-15, 2022 February 17, 2022 Part IV
November 12-13, 2022 August 18, 2022 Part IV
May 20-21, 2023 February 23, 2023 Part IV
November 11-12, 2023 August 17, 2023 Part IV


What Is A Passing Score For Part IV?

The NBCE recommends a passing score of 375 or above on the Part IV Exam. Each state has the authority to establish and recognize its own standard for passing Part IV.



Part IV $1,585


Withdrawal / Cancellation Policy

Exam Withdrawal

The NBCE will accept your written request to withdraw and issue a full refund if your request is received by the exam withdrawal deadline. Please contact the NBCE at for more information.

The NBCE will not accept withdrawal requests after the published deadline. You must submit a completely new application with correct fees when you apply at a later date.

Irregularity/Emergency Cancellation Policy

In the event of an emergency or administrative irregularity, the NBCE reserves the right to make adjustments in exam administration procedures, to withhold the reporting of scores, and/or to order the re-administration of an examination.

An emergency or administrative irregularity might include, but is not limited to, any natural disaster (hurricane, flood, tornado, earthquake, fire, etc.), power failure, technology malfunction, or other facility breakdown, which, in the opinion of the NBCE, could affect the validity of examination scores.


Part IV Detailed Description

Diagnostic Imaging

  • The DIM Exam will consist of 20 stations. You must complete all 20 stations within the allotted time (two minutes per station).
  • A question booklet will be provided, along with a scannable answer sheet on which you will mark your answers. Each station will have two multiple-choice questions concerning the condition. Each question will have four choices and you will be required to select the single most correct choice.


Chiropractic Technique

  • The Chiropractic Technique Exam will consist of five stations with five minutes allotted to complete each station. You must complete each of the five stations within the allotted time. There will be a one-minute and 30-second passing time between each station.
  • At each station, you will be provided with a written description of two vertebral or extremity listings. The instructions will include the two chiropractic techniques to be demonstrated and points of performance that will be evaluated. The instructions will include the required patient position, doctor hand contact and segmental contact.
  • You will place the patient as instructed and set up for the adjustments in a manner that is consistent with the written instructions and appropriate for the vertebral or extremity listings described in the written case scenarios.
    Note: For students who are taught an assisted/resisted model of technique, all of the set-ups on this portion of the Part IV Exam should be for assisted methods of adjustments.
  • You may also be required to demonstrate static and/or motion palpation techniques, and to describe joint-related anatomical landmarks and/or normal joint motion.
  • You will be evaluated by an examiner (licensed chiropractor) on the points of performance described in the written instructions.


Case Management

1. The Case Management Exam consists of 20 stations in which you will be required to carry out certain activities or answer questions related to a clinical case. You will have five minutes to complete each station. There will be a one-minute and 30-second passing time between each station. You must complete each of the 20 stations in the allotted time.

2. At each station, you will be required to perform one or more of the following activities:

  • Perform a brief (focused) case history
  • Perform a brief (focused) physical examination
  • Perform a brief (focused) orthopedic/neurological examination
  • Choose the most likely diagnoses and/or clinical impressions
  • Choose the most appropriate case management procedures
  • Choose the neurological signs most likely to be present
  • Choose the most appropriate orthopedic/neurological tests to perform

3. In those stations where you are asked to perform a case history, physical examination, or orthopedic or neurological test, you will be observed by an examiner (licensed chiropractor). You will perform these tests/procedures on a patient who has been trained to simulate a clinical condition.

4. You will be evaluated on your clinical skills, as well as your ability to communicate with the patient. You will be expected to treat the patient as you would treat a patient in your own practice. You will respect the patients’ dignity at all times.

5. The case history stations are case specific. You will be evaluated on your ability to fully explore the parameters of the patient’s condition and to elicit specific clinically relevant elements of the history from the patient. This specific historical information enables you to form a clinical impression and to rule in or rule out conditions of a similar nature or with similar presentation.

6. The examination stations involve demonstration of clinical tests and procedures on patients who exhibit physical signs and symptoms of specific conditions. You will be evaluated on your ability to perform these procedures within the context of a specific case, and your ability to elicit all necessary clinical signs and symptoms from the simulated patient for each of the procedures demonstrated.

7. Certain stations may require you to interact with the examiner to explain the clinical significance of a procedure or to report the examination findings of a procedure. This will be specifically explained in the station instructions, and the notation (verbal component) will follow the named test or procedure. You will perform the procedure on the simulated patient and then follow the instructions for the verbal component.

8. At the post-encounter probe (PEP) stations that immediately follow the simulated patient stations, you will be required to answer two questions related to the clinical condition exhibited by the patient. At these stations, several pages of additional clinical information related to the case will be provided, as well as patient imaging.

9. Time is very important in the Case Management Exam. Five minutes will be allotted to complete the required tasks at each station. One minute and 30 seconds will be allotted to pass from one station to the next. You will move from station to station upon hearing an audible/verbal signal. When the signal is given, you will immediately move to the next station.

Note: Success in this exam will depend on your efficient and skillful performance of the required tasks, as well as on the effective use of the allotted time.

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