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INSTRUCTIONS FOR COMPLETING THE APPLICATION ... - …

wisconsin Department of Safety and Professional Services Mail To: Box 8935 Office Location: 4822 Madison Yards Way Madison, WI 53708-8935 Madison, WI 53705 FAX #: (608) 251-3036 E-Mail: Phone #: (608) 266-2112 Website: CHIROPRACTIC EXAMINING BOARD INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR CHIROPRACTIC LICENSURE REQUIRMENTS: APPLICATION (Form #502): Complete APPLICATION (Form #502) and attach the appropriate fee. Make check payable to Department of Safety and Professional Services . Your cancelled check will be your receipt. Each applicant is required to pass a State Jurisprudence and Practical exam prescribed by the Chiropractic Examining Board per Wis.

Wisconsin law, the Department must deny your application if you are liable for delinquent State Taxes or Child Support (Wis. Stats. § 440.12 and 440.13). PLEASE TYPE OR PRINT IN INK Your name, address, telephone number, and email address are available to the public.

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