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Credentialing Help Center

Create Credentialing Account
Please note when creating your account that the user ID and password are case sensitive.
Provider First Name:
Provider Middle Name:
Provider Last Name:
Provider Suffix:
Provider Title:
Create User ID:  DO NOT USE YOUR TAX ID#. At least 1 letter required.
Create Password:
Verify Password:
E-mail Address:
Verify E-mail Address:
License State:
Chiropractic License#:
NPI Number Type 1- Individual Number:  Must be 10 digits, including leading zeros
By creating an account I agree to enroll using the online form. I understand this will utilize an electronic signature which is legally binding and compliant with the federal E-SIGN Act. I also agree to receive all disclosures and account information in an electronic format.