What Part IV is
Part IV is an OSCE (objective structured clinical examination). You move through eight stations and work with standardized patients:
| Station | How many | Time |
|---|---|---|
| Case Management | 7 | 2-minute door-chart review, 14-minute patient encounter, 6-minute SOAP note |
| Technique | 1 | 2-minute chart review, 14-minute encounter to perform 10 adjustment setups (no SOAP note) |
All in, it runs about two and a half hours.
What changed in 2026
Part IV used to rotate between testing sites. The NBCE has consolidated it into its own Assessment Center in Greeley, Colorado. The first live exam there was April 10, 2026. The center runs most weeks year-round, Friday through Sunday, with a few holiday breaks. You can book up to six months ahead, first come, first served. Exact dates show up in your MyNBCE portal once you apply. Plan travel early.
Eligibility, fees, and scoring
- Eligibility: passed Part I, and currently within six months of graduation or already graduated from an eligible college, with your registrar's online authorization.
- Fee: $1,585.
- Scoring: 125–800 scale. The NBCE's recommended passing score is 375, but states can set their own Part IV standard, so check your state board.
- Scheduling: closes 17 days before your test date. Withdrawals and refunds go through the NBCE directly.
- Retakes: you can generally retake without re-establishing eligibility unless your state board requires otherwise.
How to prepare
You can't rehearse a practical exam on a computer. What you can do:
- Run timed encounters with classmates. Fourteen minutes goes fast. Practice history, exam, and a working diagnosis inside the clock.
- Write SOAP notes in six minutes. Seven of the eight stations end with documentation, so practice getting a clean note down fast.
- Drill adjustment setups. The technique station asks for ten, so rehearse them until they're automatic.
- Keep the written content fresh. The case-management stations lean on the same diagnosis and case-management knowledge tested in Part II and Part III.
ChiroEDU doesn't sell Part IV prep, because it's a hands-on exam. If you still have Part III or Physiotherapy ahead of you, those are where our practice exams help.
Sources: NBCE Part IV · Part IV Deadlines · Part IV Planning · Redesigned Part IV · Fee Schedule. Checked September 2026; confirm details with the NBCE before you register.