If you are expanding your practice across state lines, relocating, or returning to patient care after a career hiatus, you will eventually reach out to a state licensing board. During that process, you might hear two different board exam names thrown around: NBCE Part IV and the NBCE SPEC.

Because both exams evaluate clinical competence, experienced chiropractors frequently ask: What is the difference between Part IV and SPEC, and which one will my target state board require me to take?

Understanding the key differences between these two examinations—including format, testing location, registration cost, and board eligibility—will save you time, stress, and thousands of dollars in unnecessary prep and travel fees.

Part IV vs. SPEC: The Core Differences

While both examinations were created by the National Board of Chiropractic Examiners (NBCE), they serve fundamentally different purposes and utilize entirely different testing formats.

1. What Is the NBCE Part IV Examination?

The NBCE Part IV is a hands-on, practical performance exam. It is the final clinical milestone for chiropractic college students prior to initial state licensure.

During Part IV, candidates move through physical testing stations where they:

• Interview simulated/standardized patients and take clinical histories.

• Perform orthopedic and neurological physical examination procedures.

• Interpret X-rays and advanced imaging findings.

• Demonstrate adjustive setups and chiropractic techniques on test examiners.

When Part IV May Be Required: A state board may require an experienced doctor to take Part IV if they graduated before Part IV was established, if their original state did not require Part IV at the time of their initial licensure, or if they never passed Part IV during chiropractic college.

2. What Is the NBCE SPEC Exam?

The Special Purposes Examination for Chiropractic (SPEC) is a cognitive, post-licensure evaluation designed specifically for practicing doctors.

Unlike Part IV, there are no live patient encounters or physical technique setups. Instead, the SPEC is a 4-hour, computer-based exam consisting of:

• 100 Traditional Multiple-Choice Questions (TMCQs): Testing core diagnosis, radiology, and technique theory.

• 40 Extended Multiple-Choice Cases (EMCQs): Case-based scenarios testing differential diagnosis, red flags, and referral decisions.

When the SPEC May Be Required: State boards utilize the SPEC for doctors seeking Licensure by Endorsement / Reciprocity (who have practiced actively for a required number of years), doctors reactivating a lapsed license, or doctors fulfilling board-mandated remediation.

Which Exam Do You Need? A Decision Matrix

To determine which exam pathway applies to your situation, follow these guidelines before registering:

                  ┌───────────────────────────────────────────┐
                  │ ARE YOU APPLYING TO A NEW STATE BOARD?    │
                  └─────────────────────┬─────────────────────┘
                                        │
             ┌──────────────────────────┴──────────────────────────┐
             ▼                                                     ▼
┌───────────────────────────┐                       ┌───────────────────────────┐
│     GRADUATE / STUDENT    │                       │   EXPERIENCED PRACTITIONER│
│ Seeking Initial Licensure │                       │ Licensed 3–5+ Years in    │
└────────────┬──────────────┘                       │      Another State        │
             │                                      └─────────────┬─────────────┘
             ▼                                                    ▼
┌───────────────────────────┐                       ┌───────────────────────────┐
│     NEEDS NBCE PART IV    │                       │ ASK BOARD: "Do I Qualify  │
│  (Hands-On Practical)     │                       │ for Licensure Endorsement │
└───────────────────────────┘                       │     via SPEC Exam?"       │
                                                    └─────────────┬─────────────┘
                                                                  ▼
                                                    ┌───────────────────────────┐
                                                    │     NEEDS NBCE SPEC       │
                                                    │  (Computer-Based Exam)    │
                                                    └───────────────────────────┘

Steps to Confirm Your Requirement:

1. Contact Your Target State Board: Ask their licensing department whether your practice history, year of graduation, and existing NBCE transcript qualify you for Licensure by Endorsement.

2. Confirm SPEC Eligibility: If you qualify for endorsement, confirm if passing the SPEC exam satisfies their clinical competency requirement.

3. Obtain Written Authorization: Ensure the state board transmits an official authorization letter to the NBCE before attempting to register on MyNBCE.

Prepare for the SPEC Exam with Confidence

If your state board authorizes you to take the NBCE SPEC, you don't need to worry about traveling to a chiropractic college or performing live adjusting setups. You simply need to master the 100 TMCQs and 40 EMCQ case scenarios delivered at your local Prometric center.

At Chiro AlignEd Learning, we specialize in helping experienced doctors navigate the SPEC exam:

• No Hands-On Fluff: Focus purely on the cognitive decision-making, radiology, and case management tested on the SPEC.

• Realistic EMCQ Drills: Practice multi-step patient cases matching actual NBCE test logic.

• On-Demand Access: Study around your clinic schedule without taking time off work.

Authorized by your state board for the SPEC exam?

Explore our NBCE SPEC Review Course and start prep today. Have questions? Reach out to us with questions via email at [email protected].