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By: Anna Baluch
By: Dr. Winkelmann, D.C.
Updated: February 10, 2026
Chiropractic Assistant Certification (CCCA)
Administered by the Federation of Chiropractic Licensing Boards (FCLB), the Certified Chiropractic Clinical Assistant (CCCA) sets a national standard for clinical assistants who support licensed chiropractors in patient care, documentation and clinical tasks.
According to Dr. Jason Winkelmann, Licensed Chiropractor and Chronic Pain Specialist at True Health Centers in Arvada, Colorado, the CCCA protects both patients and chiropractic offices from making harmful errors from a physical and administrative standpoint.
Similar to other professional certifications, the CCCA process requires candidates to meet eligibility requirements, gain relevant work experience, pass a test and pursue continuing education.
Who is the CCCA for?
The CCCA is a nationally recognized certification for anyone who hopes to work in a chiropractic setting, assisting licensed chiropractors with several administrative duties and patient care.
“I always recommend going for the CCCA certification because it signals professional readiness and a higher level of clinical competency, which can lead to better employment opportunities and insurance reimbursement credibility,” Winkelmann explained.
It’s important to note that the CCCA is not designed for individuals who want to provide direct clinical support.For instance, it won’t prepare you to conduct X-rays or other radiology procedures or perform front office duties.
Benefits of the CCCA
Through the CCCA, you can receive the standardized training required to support chiropractors with a variety of responsibilities. You’ll gain the knowledge and skills to educate patients, administer modalities, record vital signs, manage documentation and integrate into the care team.
“Compared to those without the certification, CCCA assistants are usually better trained, reduce errors, improve office efficiency and support better patient engagement,” Winkelmann said.
CCCA eligibility requirements
To qualify for a CCCA, you must meet the following criteria:
- Be 18 years or older and hold a high school diploma or equivalent education
- Demonstrate good moral character in the form of a clean background check
- Meet one of these two pathways:
Option 1: Complete at least 24 hours of FCLB-approved education by a Providers of Approved Continuing Education (PACE) recognized educator (online, in-person or a combination of both).
Option 2: Document 2,000 hours of supervised, hands-on chiropractic office experience under a licensed chiropractor.
What does the CCCA exam entail?
To earn the CCCA certification, you must pass an online exam proctored by a licensed chiropractor. The CCCA exam covers multiple competency domains, including:
- Foundational knowledge of chiropractic office practices and anatomy
- Patient safety and procedures, such as modalities, vital signs and basic assistive tasks
- Documentation and record keeping, including SOAP notes, billing, HIPAA and patient interactions
- Ethics, boundaries and professional conduct in a clinical chiropractic setting
The exam includes 100 multiple-choice questions and must be completed within 75 minutes. It’s your responsibility to address all questions as you won’t receive credit for those that are unanswered. Once the 75 minutes is up, the exam session will close automatically.
Are study materials available for the CCCA?
The FCLB does offer several official study materials, including:
- CCCA handbook: This includes everything you need to know about the certification process and exam.
- CCCA test plan: The test plan clearly outlines what’s covered in the exam and how each component is weighted.
How to prepare for the CCCA exam
Follow these steps to prepare for the CCCA exam:
- Verify your eligibility and apply for the exam: Once you confirm you meet all the requirements for the CCCA exam, apply online on the FCLB website. You’ll need to pay a $150 fee.
- Wait for the code: Upon approval for the exam, you’ll receive a unique code via email, which you can use to complete the exam within 90 days.
- Find a chiropractor to proctor the exam: The chiropractor must be licensed and in good standing. When you’re ready to take it, they’ll be required to sign in online and provide their credentials.
- Arrange a space to take the exam: Work with the chiropractor to find somewhere to take the exam. The FCLB recommends a quiet, well-lit area with reliable internet access.
- Schedule your exam session: Use your unique code and coordinate with your proctoring chiropractor to determine an exam time and schedule it on the FCLB website.
What to expect after the exam
After you complete the CCCA exam, you will receive your results immediately. If you pass, you’ll receive instructions on how to print the certificate and renew the certification. In the event you do not pass, the FCLB will provide an analysis to help you identify which questions you missed.
To retake the CCCA exam, you must pay the $100 retake fee and log into the CCCA website again. While you may retake the exam as often as you want, the FCLB requires you to wait seven days between exams.
Maintaining your CCCA certification
Once you receive a CCCA, you must engage in continuing education (CE) and recertification. The FCLB mandates six hours of continuing education every two years plus a $35 fee. “Many state chiropractic boards also require CE hours relevant to modalities such as X-rays,” Winkelmann explained.
Is the CCCA transferable?
Since the CCCA is nationally recognized, it’s broadly transferable and credible across states. Even if you don’t plan to move, Winkelmann recommended you earn the certification as it can open the doors to more job opportunities and position you as a credible chiropractic assistant.
CCCA vs. popular medical assistant certifications
While many medical assistant certifications focus on general duties in a variety of healthcare settings, such as doctor’s offices, hospitals and outpatient clinics, the CCCA is more niche in that it’s geared toward supporting chiropractors.
For this reason, it’s important to ensure you actually want to work in a chiropractic setting before you pursue it. “It is not uncommon for someone to go through the certification, start employment and then realize they do not care for either the physical work or the administrative work after it is too late,” Winkelmann said.