Licensing and certification of CAM practitioners

DEFINITION: The regulation of complementary and alternative medicine practice through licensing and certification.

Requirements for Practice

Licensure is a process in which the government reviews and verifies the credentials of a health care practitioner and then grants a license to practice within a given state. Certification is a credential issued by a professional organization that represents a complementary and alternative medicine (CAM) specialty. Persons seeking certification must pass a test of their knowledge of the specialty. Licensing is required to practice, but credentialing may not be.

In the United States, licensure for CAM practitioners is provided by the state in which the person seeks to practice. Licensure most often requires educational credentials and the passing of an examination that demonstrates the practitioner’s knowledge. All licensed CAM practitioners are required to complete a specified number of hours of continuing education annually to maintain their licenses. Licensure and certification requirements for CAM practitioners vary with the CAM field. The CAM practices discussed here are chiropractic, acupuncture, homeopathy, osteopathy, naturopathy, midwifery, massage therapy, and hypnosis.

Licensing

Chiropractors. Chiropractors must be licensed as a Doctor of Chiropractic in all fifty US states and the District of Columbia. To be licensed, a chiropractor must complete four years of chiropractic education and then must pass the National Board of Chiropractic Examiners examination or a state-prepared examination.

Acupuncturists. Physician acupuncturists, as distinguished from nonphysician acupuncturists, can practice in any state and are, according to the American Academy of Medical Acupuncture, required to have medical training and two hundred and twenty hours of acupuncture training, including one hundred and twenty hours of didactic training and one hundred hours of clinical training. Some states may require more hours. Nonphysician acupuncturists receive different credentials depending on the type of acupuncture training program they attended. A nonphysician acupuncturist can be a certified acupuncturist, a licensed acupuncturist, a diplomate of acupuncture, or a master or doctor of Oriental medicine.

Training in acupuncture takes from two to four years and often includes clinical internships. Licensing of nonphysician acupuncturists varies by state. Many states license certified acupuncturists, but some have no regulations regarding acupuncture. Some states permit only physician acupuncturists to practice.

Homeopaths. Arizona, Connecticut, and Nevada are the only states that license homeopaths; homeopaths in these states are required to be medical doctors. Rhode Island, California, New Mexico, Colorado, and Minnesota permit homeopaths to practice without a license under health freedom laws. Homeopaths are not permitted to practice in the remaining states. General homeopathic education lasts four years, but it is shorter for already licensed medical doctors. However, in Arizona, California, Connecticut, the District of Columbia, Idaho, Kansas, Maine, Minnesota, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington, naturopathic licenses include homeopathy.

Naturopaths. Twenty-six jurisdictions in the United States have licensure or registration requirements for naturopaths. For licensure, naturopaths must complete four years of naturopathic medical college and pass the Naturopathic Physicians Licensing Examination. Several states also require that naturopaths be qualified to practice natural childbirth or acupuncture or to dispense natural substances. In Tennessee, Florida, and South Carolina, practicing naturopathy is illegal. In California, Colorado, Idaho, New Mexico, Minnesota, Pennsylvania, and Wisconsin, licensure or registration is offered but not required, provided practitioners do not market themselves as registered or licensed naturopaths. The remaining states do not license naturopaths, and some do not permit them to practice.

Osteopaths. Osteopaths are licensed as medical doctors in all US states. Medical licensure requires graduation from an accredited medical or osteopathic school, an internship and residency, and, possibly, a fellowship in a specialty. In addition, they must pass either the US Medical Licensing Exam or the Comprehensive Osteopathic Medical Licensing Exam.

Massage therapists. Massage therapists are licensed in forty-five US states and the District of Columbia. Licensure requirements vary by state, but many require massage therapists to pass an examination and obtain certification, which includes both clinical and didactic hours.

Midwives. Midwives can be either nurse-midwives or non-nurse midwives (including Certified Midwives [CMs] and Certified Professional Midwives [CPMs]). Most midwives in the US are nurse-midwives. Non-nurse midwives are permitted to practice only in more than thirty-five states. Non-nurse midwives can attend a midwifery school and then serve as apprentices to licensed midwives. In Arizona, they must pass a state examination. Nurse-midwives must have a bachelor’s degree in nursing and a master’s degree in nursing with a concentration in midwifery. They must pass a nurse licensing examination and an advanced practice nursing examination, then work as an intern or apprentice for about two years in an emergency room, clinic, hospital, or an obstetrician’s office. To be licensed, nurse-midwives must pass the American Midwifery Certification Board exam.

Hypnotists. The states of Colorado, Connecticut, and Washington require hypnotherapists to be licensed. In Colorado, they can be licensed as psychotherapists or listed on an unlicensed psychotherapist database. Some of the remaining states have regulations regarding the practice of hypnosis. California, Florida, Illinois, New Jersey, Texas, and Utah do not have mandatory registration but do set specific regulations for the practice of hypnotism and guidelines for licensure exemptions. The remaining states may require that hypnotists hold additional medical credentials, while others treat hypnotists as businesspeople and require no credentialing.

Certification

No formal certification process exists for chiropractors. Nonphysician acupuncturists have to be certified to be licensed, but physician acupuncturists do not. To be certified, nonphysician acupuncturists must pass the National Certification Commission of Acupuncture and Oriental Medicine examination.

Medical doctors and osteopaths who become homeopaths can be certified by the American Board of Homeotherapeutics. They must be educated in homeopathy and must pass oral and written examinations. Nonphysician homeopaths can achieve certification by passing the examination of the Council for Homeopathic Certification. This credential is not required for state licensure.

Naturopaths do not have a certification process. Osteopaths can become board-certified in their specialty, but board certification is not required for licensure. Massage therapists must be certified to practice. They can become certified by passing the MBLEx (Massage and Bodywork Licensing Examination), administered by the Federation of State Massage Therapy Boards. Additionally, the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) offers a voluntary, higher-level certification to experienced therapists through the Board Certification Exam (BCETMB).

A certification process exists for hypnotists, but it is not required for state licensure. The American Council of Hypnotist Examiners certifies hypnotists who pass its examination. Nurse-midwives must be certified to be licensed. Non-nurse midwives may become certified by the North American Registry of Midwives as certified professional midwives after completing their education.

Bibliography

"Credentialing, Licensing, and Education." National Center for Complementary and Integrative Health, www.nccih.nih.gov/health/credentialing-licensing-and-education. Accessed 10 Dec. 2025.

"Homeopathy Practice and the Law: A Guide for Homeopathy Practitioners in the United States and Canada." North American Society of Homeopaths, 9 Dec. 2022, homeopathy.org/wp-content/uploads/2023/01/Homeopathy-Practice-and-the-Law-Dec-2022.pdf. Accessed 10 Dec. 2025.

“International Association of Hypnotherapists - Hypnosis Law.” Institute of Interpersonal Hypnotherapy, www.instituteofhypnotherapy.com/iaih-hypnosis-law. Accessed 10 Dec. 2025.

“Massage Therapy State Licensing Requirements.” Associated Bodywork & Massage Professionals, www.abmp.com/practitioners/state-requirements. Accessed 10 Dec. 2025.

“Naturopathic Doctor Licensure -  List of States and Provinces.” AANMC, aanmc.org/licensure. Accessed 10 Dec. 2025.

Pokladnikova, Jitka, and Ivo Telec. "Provision of Complementary and Alternative Medicine: Compliance with the Health Professional Requirements." Health Policy, vol. 124, no. 3, Mar. 2020, pp. 311-16, doi:10.1016/j.healthpol.2020.01.009. Accessed 10 Dec. 2025.

“Study Chiropractic.” Association of Chiropractic Colleges, www.chirocolleges.org/students/study-chiropractic. Accessed 10 Dec. 2025.

Tierney, Gillian. Opportunities in Holistic Health Care Careers. Rev. ed., McGraw-Hill, 2007.