Offices of Chiropractors (U.S.) — NAICS 621310

An investor's primer for a general audience — relevant to both public-market and private investors. NAICS = North American Industry Classification System, the federal code that defines this industry.

1. Overview

Offices of chiropractors are the clinics where a licensed Doctor of Chiropractic (DC) treats musculoskeletal complaints — mostly back and neck pain — chiefly through hands-on spinal manipulation (an "adjustment"). It is a large, cash-heavy, and extraordinarily fragmented corner of U.S. health care: tens of thousands of small, owner-operated offices, most run by a single practitioner, competing block by block rather than nationally [1][4].

Why it matters to investors: demand is steady and only lightly cyclical, the service is delivered in low-cost storefronts (not hospitals), and a meaningful slice of revenue is paid in cash rather than routed through insurers — which makes the unit economics unusually transparent and the roll-up math attractive. That has pulled in franchisors and private-equity-backed operators over the past decade.

The catch: this is a private-market industry first. Nearly all the value sits in privately owned practices and private roll-up platforms; public-market access is limited to a single small franchisor plus a few adjacent (non-chiropractic) rehabilitation companies. So the realistic ways in are (a) private routes — buying or building a practice, franchise ownership, or investing alongside the management-services consolidators — or (b) one micro-cap public stock covered in Section 4.

2. What it is, and how it's structured

Scope (what's inside 621310). Establishments of health practitioners holding a Doctor of Chiropractic degree, primarily engaged in the independent practice of chiropractic — diagnostic and therapeutic treatment of neuromusculoskeletal disorders through spinal-column and extremity manipulation. The core billable act is spinal manipulation; offices often add adjacent services (physiotherapy modalities, therapeutic exercise, massage, nutritional advice) where their state license allows. Practices may be solo or group-owned and may operate in their own offices, in hospitals, or in HMO (health-maintenance-organization) facilities [4].

What it excludes — and the adjacent NAICS codes. The classification is narrow. It does not include:

• 621111 — Offices of Physicians (MDs and DOs, including physical-medicine and pain-management doctors).
• 621210 — Offices of Dentists.
• 621340 — Offices of Physical, Occupational and Speech Therapists and Audiologists (physical therapy is the closest competing profession).
• 621399 — Offices of All Other Miscellaneous Health Practitioners (acupuncturists, dietitians, etc.).
• 621498 — All Other Outpatient Care Centers, 812199 — Other Personal Care Services (stand-alone massage and wellness studios), and 713940 — Fitness and Recreational Sports Centers.

The distinction matters because chiropractors compete directly for the same back-and-neck-pain patient with physical therapists (621340) and physicians (621111), and the "wellness" end of a chiropractic office blurs into personal-care and fitness businesses. An integrated clinic can earn revenue from several activities but is classified by its primary business [4].

Ownership mix. Historically almost entirely independent professional practices — a DC who owns the clinic and treats patients; a company filing describes most chiropractic practices as sole-practitioner businesses [8]. Because many states apply a "corporate practice of medicine" doctrine (only a licensed clinician may own a clinical practice), outside capital typically enters through a stack of entities:

• The clinical practice employs or contracts with the licensed chiropractors.
• A professional corporation (PC), owned by a licensed DC, may hold the clinical entity where state law restricts corporate ownership.
• A management services organization (MSO) — owned by the investor — provides the office, staff, billing, marketing, technology, and leases under a services contract, while the DC-owned PC retains clinical control.

This is the same structure used to roll up dental and veterinary offices. Franchising is the other consolidation vehicle: the franchisor supplies brand, training, software, and operating systems while local franchisees own the clinics and hold the licenses. The federal data do not report what share of practices is owned by chiropractors, investors, or franchisees.

3. How big it is

Federal business statistics (our ground truth) count only employer businesses — those with paid W-2 staff. Dollar figures below are converted from thousands; the years differ because the sources are different federal programs.

The HHI (a standard market-concentration measure) is suppressed in the federal data, so we do not report it. The Small Business Administration (SBA) size standard of $9.0 million means virtually every business in this industry qualifies as a small business [3] — that threshold is a government-program cutoff, not a typical practice valuation or a market-size estimate.

The undercount caveat — important here. The 39,913 figure counts offices with payroll. County Business Patterns (CBP) excludes the self-employed, businesses without an employer identification number, and those with an EIN but no employees [5] — exactly the profile of a solo DC with no W-2 staff, which dominates this profession. Two cross-checks show the gap:

• The Bureau of Labor Statistics (BLS) counts about 57,200 chiropractor jobs as an occupation in 2024, and industry groups cite 70,000-plus licensed DCs — more practitioners than there are employer offices [6].
• Private market-research houses that fold in nonemployers put total industry revenue near $20 billion and total chiropractic businesses around 65,000 [7].

The Census Bureau publishes separate Nonemployer Statistics, but our ground-truth file does not include a 621310 nonemployer count or receipts, so we add no federal total-market figure [5]. Read the federal employer figures as a floor: the real office count and total spend are materially higher once solo, no-payroll practices are included. The $15.88 billion Economic Census receipts number is the employer-only revenue base [2].

Workforce economics. BLS reports a median wage of $79,000 for chiropractors in May 2024 (bottom 10% under about $44,780; top 10% over about $149,990), with employment projected to grow 10% from 2024 to 2034 — faster than average — and about 2,800 openings a year [6]. Note the median reflects employed/associate DCs; owner-operators' take-home depends on practice profit, not salary.

4. The investable universe

Public companies. There is one U.S.-listed pure play, plus two adjacent (non-chiropractic) rehabilitation names.

The Joint is effectively the entire direct listed opportunity set. There is no large-cap chiropractic operator, no chiropractic REIT, and no diversified public chain. Note the gap between The Joint's ~$54.9M of company revenue and ~$532.4M of system-wide clinic sales: franchisee sales are not recorded as corporate revenue [8]. Other public exposure is indirect — patient-financing lenders (e.g., CareCredit/Synchrony) that fund elective care, or practice-software and medical-device vendors that sell into the sector — none a chiropractic pure play.

Major private / other owners. The consolidating tier is private:

• Chiro One Wellness Centers (Medulla) — a Midwest-heavy MSO platform; its own site lists roughly 150 clinics, and The Vistria Group lists Chiro One as a healthcare portfolio company [12].
• 100% Chiropractic — a franchise brand that reported 125 locations in mid-2024; Red Iron Group made a strategic growth investment, with founders Jason and Vanessa Helfrich remaining significant shareholders [14].
• HealthSource Chiropractic — a franchise network reporting 130-plus owners, combining chiropractic with rehabilitation and wellness services [13].
• Private-equity-backed MSO/roll-up platforms and buyers more broadly — industry M&A advisers describe sponsors applying the dental-service-organization playbook to chiropractic; ~15-20% of the market is estimated to be "corporately aligned" across franchise, MSO, and PE-backed operators [15].
• Tens of thousands of independent single-doctor practices, which still hold the overwhelming majority of the market.

5. How the money works

Chiropractic is a visit-volume, price-per-visit business — the relevant unit economics are patient visits per week, revenue collected per visit, and how much survives fixed office overhead.

Revenue per visit and payer mix. Two revenue models coexist, and the mix varies substantially by state, payer, and clinical model:

• Insurance / third-party billing (Medicare, commercial plans, workers' compensation, auto/personal-injury). Reimbursement per adjustment is low and under pressure — roughly $60-$90 per visit in insurance-heavy practices per trade surveys — and chiropractors report collecting only about 57% of what they bill commercial insurers [16].
• Cash / out-of-pocket (including memberships and prepaid care plans). A far larger share of chiropractic revenue is paid directly by patients than in general medicine — trade surveys put roughly 30-50% of chiropractic patients as cash-pay, versus 10-20% in a typical medical office — and cash/blended practices realize $120-$200+ per visit [16]. Some offices run fully cash, no-insurance models.

The cost base is mostly labor and occupancy: chiropractor and associate compensation; front-desk and therapy labor; rent and leasehold; marketing and patient acquisition; billing, credentialing and collections; malpractice and business insurance; and software, supplies and equipment. The operating metrics that matter are not manufacturing-style utilization rates — they are visits per clinic and per provider, schedule fill, new-patient conversion and retention, visits per patient, same-clinic revenue, payer mix, collection and denial rates, clinician turnover, rent, and marketing cost per acquired patient.

Owner economics (the independent practice). An owner-DC's profit is collections minus rent, front-desk and assistant labor, malpractice, equipment and billing. Because the storefront is cheap and the practitioner is the main "asset," a busy solo office can throw off healthy owner cash flow; the binding constraints are new-patient flow and the owner's own clinical hours. This is why so many practices stay solo — the model doesn't automatically scale past one or two doctors.

The subscription twist (the franchise model). The Joint Corp. built its business entirely on cash: no insurance, a low-price monthly membership/wellness-plan model, walk-in convenience, and no appointments. That trades high reimbursement per visit for high volume and predictable recurring revenue. Its average franchised clinic grossed roughly $570,000 in 2024, with the top quartile near $913,000 [9].

Franchisor economics (the public-stock lens). For a franchisor like The Joint, the money is a royalty stream: it collects about 7% of each franchised clinic's gross sales plus a 2% marketing-fund contribution, franchise fees, software fees and other vendor income (standard franchise agreements run a 10-year initial term) [8]. Its revenue therefore tracks system-wide sales and comparable-clinic (same-clinic) sales growth, not per-visit reimbursement. The company is deliberately shifting toward a near-pure, capital-light franchisor (refranchising corporate clinics), which lifts margins and reduces exposure to clinic-level operating costs — so a franchisor can enjoy high-margin recurring royalties while the underlying owners still bear labor, rent, payer, and patient-acquisition risk.

Roll-up economics (the private-equity lens). MSO consolidators buy individual practices at low multiples of clinic earnings, bolt dozens of them onto a platform over several years, then sell the larger, more "institutional" platform at a higher multiple. The spread between the small-practice acquisition multiple and the platform exit multiple is the return engine — earnings here are usually measured in EBITDA (earnings before interest, taxes, depreciation and amortization) [15].

6. What drives demand

• Broad and rising consumer use. The National Center for Complementary and Integrative Health (NCCIH) reports 11.0% of U.S. adults received chiropractic care in 2022, up from 7.4% in 2002 [18]. Private research puts annual users above 35 million [7].
• Back and neck pain prevalence. Musculoskeletal complaints are among the most common reasons Americans seek any care; low-back pain is a leading cause of disability. An aging population and sedentary/desk work both expand the pain-prone base.
• The opioid-alternative shift. The Centers for Disease Control and Prevention (CDC) 2022 guideline recommends prioritizing nonopioid and nonpharmacologic approaches for subacute and chronic pain, and lists spinal manipulation among noninvasive options for some low-back-pain patients [19]; peer-reviewed studies associate initial chiropractic care with sharply lower odds of an opioid prescription for low-back pain [17]. This is a structural tailwind increasingly reflected in insurer and employer musculoskeletal programs.
• Convenience and cash-pay access. Walk-in clinics, extended hours, memberships, transparent pricing, and retail locations attract patients who prefer to avoid insurance administration.
• Discretionary wellness spending. The cash-pay and membership segments ride consumer willingness to pay out of pocket for maintenance and wellness care — which rises with disposable income and softens in downturns.

7. Regulation

• State licensure, not federal. Chiropractic is licensed in all 50 states plus D.C. and the territories, and scope of practice varies widely by state — the single most important regulatory variable, because it determines what an office can bill for. A DC must graduate from an accredited program and pass the multi-part exam of the National Board of Chiropractic Examiners (NBCE), which state boards use for licensure; the NBCE tests but does not itself license [21].
• Medicare coverage is narrow. Medicare Part B (administered by the Centers for Medicare & Medicaid Services, CMS) covers only manual manipulation of the spine to correct a subluxation — not exams, X-rays, or therapies a DC orders. Codes are Chiropractic Manipulative Treatment (CMT) 98940-98942; each claim needs the "AT" (active treatment) modifier and documentation of expected improvement, and ongoing maintenance care is not covered. 2024 rates were roughly $27 (1-2 spinal regions) to $39 (3-4 regions) per adjustment [20]. This narrow coverage, plus audit and documentation risk, is a persistent revenue and compliance headwind.
• Corporate-practice-of-medicine (CPOM) and fee-splitting rules in many states force outside investors into the MSO/PC structure described in Section 2; nonclinical control over clinical decisions can create legal risk [8].
• The FTC Franchise Rule. Franchisors must give prospective franchisees a Franchise Disclosure Document (FDD) covering 23 information categories, generally at least 14 days before signing or payment — the disclosure backbone of the franchise route [22].
• HIPAA (the Health Insurance Portability and Accountability Act) applies to clinics that conduct covered electronic transactions such as standardized claims or eligibility checks, governing patient-record privacy and security [23].
• The No Surprises Act requires good-faith cost estimates for many uninsured and self-pay patients who schedule care [24].
• Commercial payer rules (visit caps, prior authorization, medical-necessity review) and workers'-compensation/personal-injury regulation further govern the insurance side.

8. Competitive dynamics & consolidation

This is one of the most fragmented industries in the federal data. The largest four firms account for just 1.3% of receipts; the top eight, 1.9%; the top 20, 2.9%; the top 50, 4.4% [2]. No operator has meaningful national share.

Competition is intensely local and relationship-driven: clinician reputation and outcomes, location, convenience, price, online visibility, payer participation, referral relationships, and the ability to recruit and retain DCs. Chiropractors also compete across professional lines with physical therapists, pain physicians, massage therapists, and at-home/self-care options.

Two forces are slowly consolidating the base:

1. Franchising — The Joint's cash-membership model showed that a branded, standardized, convenience-first clinic can scale, and it remains the visible franchise leader (~960 clinics) [8]. 100% Chiropractic and HealthSource demonstrate private-capital-backed and franchise-network variants [13][14].
2. MSO / private-equity roll-ups — sponsors are applying the dental-service-organization (DSO) playbook, aggregating independents onto managed platforms; Chiro One (Vistria-backed) is a prominent centralized-ownership example [12][15].

Consolidation is possible but not automatic: small practices are hard to standardize, many owners are clinically essential to their own clinics, and state corporate-practice rules require doctor-owned clinical entities. Industry observers estimate only about 15-20% of the market is "corporately aligned" today [15] — the rest is still independent.

9. Risks

• Reimbursement compression. Commercial and Medicare payment per adjustment is low and under pressure; insurance-reliant practices face declining collection rates [16][20].
• Discretionary / cyclical cash revenue. The cash-pay and membership base is sensitive to consumer budgets; a recession hits maintenance and wellness visits first.
• Regulatory and compliance risk. Narrow Medicare coverage, the AT-modifier and medical-necessity rules, HIPAA and No Surprises Act obligations, and state-by-state scope and corporate-practice limits create denial, audit, and structural exposure; changes to fee-splitting, referral, advertising, or franchise rules can disrupt MSO and franchise structures.
• Clinician dependence and labor. A practice can lose much of its value if the founding DC leaves; recruiting associate DCs constrains multi-provider growth. The large cohort of aging solo owners faces a succession/exit question — a risk for owners, an opportunity for consolidators.
• Clinical safety and reputation. Serious adverse events are rare but real (cervical manipulation has been linked to rare vascular injury), and periodic evidence-and-efficacy debates affect payer and public perception.
• Consolidation execution. Roll-ups can fail if patient retention, clinician culture, billing systems, or local reputations deteriorate after acquisition; a franchisor's royalty stream depends on franchisee health and compliance.
• Cybersecurity and privacy. Clinics handle sensitive health and payment data.
• Single-stock concentration risk (public investors). With one micro-cap direct pure play, public exposure carries company-specific and liquidity risk that is not diversifiable within the sector; JYNT's market value fell roughly 30% year-over-year into mid-2026 [11].
• Data limitations. Federal employer statistics omit nonemployers, and our ground-truth file provides no average revenue per clinic, payer mix, capacity-utilization measure, or nonemployer receipts.

10. How to invest, and the outlook

Public-market routes.

• The Joint Corp. (JYNT) is the only direct listed exposure — a micro-cap franchisor whose thesis rests on royalty growth from system-wide sales, comparable-clinic sales, the refranchising-to-capital-light margin story, and unit expansion [8][10]. Investors here are buying a franchise business, not the broad industry: watch franchisee unit economics, royalty collections, same-clinic comps, clinic openings and closures, company-clinic divestitures, and cash generation — not reimbursement rates. As a thinly traded small-cap, it carries outsized volatility and liquidity risk [11].
• Adjacent (non-chiropractic) rehab names — U.S. Physical Therapy (USPH) and Select Medical (SEM) — may benefit from the same musculoskeletal-care demand but should be analyzed as broader rehabilitation businesses, not chiropractic proxies [25][26].

Private routes (where most of the real exposure lives).

• Own or build a practice — direct operator economics, driven by patient volume, payer mix, and the owner's clinical hours.
• Franchise ownership — a lower-friction way to operate under a proven brand and system, at the cost of royalties and standardization.
• Invest alongside MSO/PE roll-ups — participate in the consolidation arbitrage, subject to private-market illiquidity and sponsor selection.

Private investors should underwrite normalized owner cash flow, not headline revenue. Essential diligence: visits and collections by provider; new-patient sources and retention; payer mix and reimbursement history; clinician compensation and turnover; lease terms and local competition; malpractice and regulatory history; billing/coding/denial controls; the state ownership structure; dependence on the selling doctor; patient-record transfer and privacy compliance; and franchise fees and restrictions where applicable.

Outlook (forward-looking). The demand picture is favorable: back-pain prevalence is not going away, chiropractic use is rising (11.0% of adults in 2022), the opioid-alternative shift is a durable tailwind, and BLS projects 10% practitioner growth through 2034 [6][18][19]. But growth is not uniform across operators — The Joint reported roughly flat system-wide sales and a ~0.4% decline in comparable-clinic sales in 2025 [10]. Against the tailwinds, per-visit reimbursement is likely to stay soft, and the cash-pay segment leaves the industry exposed to consumer-spending cycles. Selective consolidation should keep advancing from a low base as aging solo owners sell and MSO/franchise platforms scale, which over time could modestly raise concentration from today's near-zero levels [15]. The most investable structural story is less "chiropractic demand" (steady but unspectacular) than the professionalization and roll-up of a still-fragmented cottage industry — a private-market thesis first, with only a single small public proxy.

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Sources

1. U.S. Census Bureau, County Business Patterns 2023 (NAICS 621310 — establishments, employment, annual and Q1 payroll). https://www.census.gov/programs-surveys/cbp.html
2. U.S. Census Bureau, 2022 Economic Census — Concentration of Largest Firms (NAICS 621310 — firms, receipts, CR4/CR8/CR20/CR50 revenue shares; HHI suppressed). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
3. U.S. Small Business Administration, Table of Size Standards (NAICS 621310, $9.0 million receipts), 2023. https://www.sba.gov/document/support-table-size-standards
4. U.S. Census Bureau, NAICS 2022 — 621310 Offices of Chiropractors (industry definition and exclusions). https://www.census.gov/naics/?details=621310&year=2022
5. U.S. Census Bureau, County Business Patterns Methodology (nonemployer exclusion) and Nonemployer Statistics program overview. https://www.census.gov/programs-surveys/cbp/technical-documentation/methodology.html; https://www.census.gov/econ/overview/mu0500.html
6. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Chiropractors (2024 median pay $79,000; ~57,200 jobs; +10% 2024-34; ~2,800 openings/yr), 2025. https://www.bls.gov/ooh/healthcare/chiropractors.htm
7. IBISWorld, Chiropractors in the US — Market Size (industry revenue ~$20B; ~65,000 businesses; 35M+ annual users), 2024-2026. https://www.ibisworld.com/united-states/industry/chiropractors/1559/
8. U.S. Securities and Exchange Commission, The Joint Corp., Form 10-K for the year ended Dec. 31, 2025 (clinic count 960; 885 franchised / 75 company-owned or managed; 7% royalty; 2% marketing fee; 10-year franchise term; CPOM/MSO structure; sole-practitioner market description), 2026. https://www.sec.gov/Archives/edgar/data/1612630/000161263026000022/jynt-20251231.htm
9. The Joint Corp., Fourth Quarter and Year-End 2024 Results / Franchise Disclosure (2024 system-wide sales ~$530M; average franchised clinic gross ~$570,000, top quartile ~$913,000), 2025. https://ir.thejoint.com/press-releases/detail/282/the-joint-corp-reports-fourth-quarter-and-year-end-2024
10. The Joint Corp., FY2025 results / 2026 Letter to Stockholders (FY2025 company revenue ~$54.9M; system-wide sales ~$532.4M, roughly flat; comparable-clinic sales ~-0.4%), 2026. https://ir.thejoint.com/annual-general-meeting
11. StockAnalysis / Macrotrends, The Joint Corp. (JYNT) Market Cap (~$120M mid-2026; ~30% YoY decline). https://stockanalysis.com/stocks/jynt/market-cap/
12. Chiro One / Medulla, company website (clinic count) and The Vistria Group healthcare portfolio listing. https://www.chiroone.com/; https://vistria.com/portfolio_category/healthcare-companies/
13. HealthSource Chiropractic, The HealthSource Story (franchise network, 130-plus owners), 2026. https://www.healthsourcechiro.com/franchise/research/the-healthsource-story/
14. Red Iron Group, Strategic Investment in 100% Chiropractic (PR Newswire), 2024; 100% Chiropractic, First Half of 2024 — 125 locations, 12 openings, 2024. https://www.prnewswire.com/news-releases/red-iron-group-announces-strategic-investment-in-100-chiropractic-302164167.html
15. CT Acquisitions, Chiropractic Exit / Owner's Guide to Valuation and PE Buyers (MSO/PE roll-up trends, deal multiples, ~15-20% corporately aligned), 2026; Chiropractic Economics, The Consolidation of the Chiropractic Profession, 2024. https://ctacquisitions.com/prepare-your-business-for-sale/chiropractic-exit/; https://www.chiroeco.com/the-consolidation-of-the-chiropractic-profession/
16. Chiropractic Economics, Annual Fees & Reimbursements Survey, and ChiroTouch, The State of Chiropractic Billing (cash-pay share 30-50%; revenue per visit; ~57% commercial collection), 2022-2024. https://www.chiroeco.com/reimbursements-survey/; https://www.chirotouch.com/article/the-state-of-chiropractic-billing
17. Whedon et al. / PMC, research on chiropractic care and reduced opioid prescribing for spine/low-back pain. https://pmc.ncbi.nlm.nih.gov/articles/PMC10973298/
18. National Center for Complementary and Integrative Health, Spinal Manipulation: What You Need to Know (11.0% of U.S. adults used chiropractic care in 2022 vs 7.4% in 2002). https://www.nccih.nih.gov/health/spinal-manipulation-what-you-need-to-know
19. Centers for Disease Control and Prevention, CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
20. Centers for Medicare & Medicaid Services, Medicare Coverage — Chiropractic Services and Documentation Checklist for Chiropractic Doctors (Part B covers only manual spinal manipulation; CMT codes 98940-98942; AT modifier; no maintenance care; 2024 rates ~$27-$39). https://www.medicare.gov/coverage/chiropractic-services; https://www.cms.gov/files/document/mln1232664-medicare-documentation-checklist-chiropractic-doctors.pdf
21. National Board of Chiropractic Examiners, Certification and Licensure (multi-part exam used by state boards; state licensure). https://www.nbce.org/about-nbce/chiropractic-care/certification-and-licensure/
22. Federal Trade Commission, A Consumer's Guide to Buying a Franchise (Franchise Rule; FDD with 23 items; 14-day disclosure), 2020. https://www.ftc.gov/business-guidance/resources/consumers-guide-buying-franchise
23. U.S. Department of Health and Human Services, HIPAA — Covered Entities and Business Associates, 2024. https://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html
24. Centers for Medicare & Medicaid Services, No Surprises Act — Know Your Rights Without Insurance (good-faith estimates for uninsured/self-pay), 2024. https://www.cms.gov/medical-bill-rights/know-your-rights/no-insurance
25. U.S. Physical Therapy, Inc., Investor Relations / FAQs (outpatient PT, adjacent to chiropractic), 2026. https://www.usph.com/investor-relations/investor-faqs/
26. U.S. Securities and Exchange Commission, Select Medical Holdings Corp., Form 10-K for the year ended Dec. 31, 2025 (broad rehabilitation and outpatient services). https://www.sec.gov/Archives/edgar/data/1320414/000132041426000007/sem-20251231.htm