Offices of Chiropractors (U.S.) — NAICS 62131

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. This is a rollup page: NAICS 62131 is a five-digit "industry" that contains a single six-digit child, and it is effectively identical to that child. For full detail, see the 621310 primer.

1. Overview

NAICS 62131 is the federal five-digit industry "Offices of Chiropractors." It has exactly one child code — 621310, which carries the same name — so this level and its child describe the identical set of businesses: 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, mostly single-practitioner offices competing block by block rather than nationally [1][2].

For investors the takeaway is the same as at the child level: this is a private-market industry first. Almost all the value sits in privately owned practices and private roll-up platforms; listed public access is limited to a single small franchisor plus a few adjacent (non-chiropractic) rehabilitation names. Read the 621310 primer for the full treatment; this page gives the rollup's own federal figures and points you down.

2. What's inside — and why this level equals its one child

The five-digit industry 62131 contains a single six-digit national industry:

Because there is only one child, the rollup adds nothing the child does not already contain — no sibling industries to aggregate, no mix to weigh. Everything true of 621310 is true here: the scope (establishments of DC-degree health practitioners primarily engaged in the independent practice of chiropractic, centered on spinal manipulation), the exclusions (physicians' offices 621111, dentists 621210, physical/occupational/speech therapists 621340, other miscellaneous health practitioners 621399), and the ownership structure (mostly independent doctor-owned practices, with outside capital entering through management-services-organization/professional-corporation stacks or franchising) all carry over unchanged [4]. This page is therefore a short pass-through; for definitions, scope boundaries, and the ownership mix, see Section 2 of the 621310 primer.

3. Size (this level's rollup figures)

The figures below are our ground-truth federal stats reported at the 62131 level. They match the child's because the level equals its child. Federal business statistics here count only employer businesses — those with paid W-2 staff. Dollar figures are converted from thousands; 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.

Undercount caveat — important here. These are employer-only counts. County Business Patterns (CBP) excludes the self-employed and businesses with no paid employees [1] — exactly the profile of a solo DC with no W-2 staff, which dominates this profession. External cross-checks show the gap: the Bureau of Labor Statistics counts about 57,200 chiropractor jobs in 2024 and industry groups cite 70,000-plus licensed DCs, while private research houses that fold in nonemployers put total industry revenue near $20 billion and total chiropractic businesses around 65,000 [6][7]. Our ground-truth file contains no 62131 nonemployer count or receipts, so we add no federal total-market figure — read the $15.88 billion receipts and 39,913 offices as a floor, with the real total materially higher once solo, no-payroll practices are included.

4. Investable universe (where value concentrates)

With one child, there is nowhere else for value to sit — it is all in 621310. The concentration is the headline: the largest four firms account for just 1.3% of receipts, the top 50 only 4.4% [2], so no operator has meaningful national share and the "universe" is tens of thousands of independent practices.

Direct listed exposure is a single micro-cap franchisor, The Joint Corp. (Nasdaq: JYNT) — franchisor/operator of cash-based "The Joint Chiropractic" membership clinics, roughly 960 clinics at year-end 2025, FY2025 company revenue about $54.9 million against system-wide clinic sales of about $532.4 million [8][10]. The consolidating private tier — franchise brands (100% Chiropractic, HealthSource) and management-services-organization roll-ups (Chiro One/Medulla) — holds an estimated 15-20% "corporately aligned" slice, with independents holding the rest [12][13][14][15]. Adjacent (non-chiropractic) rehab names such as U.S. Physical Therapy (NYSE: USPH) and Select Medical (NYSE: SEM) compete for the same musculoskeletal patient but are not chiropractic pure plays . See Section 4 of the 621310 primer for the full company-by-company detail.

5. How the money works

Chiropractic is a visit-volume, price-per-visit business — the unit economics are patient visits per week, revenue collected per visit, and how much survives fixed office overhead. Two revenue models coexist: insurance / third-party billing (Medicare, commercial, workers' compensation, auto/personal-injury), where reimbursement per adjustment is low and under pressure (roughly $60-$90 per visit, with only about 57% of billed commercial charges collected), and cash / out-of-pocket (including memberships and prepaid plans), where a far larger share of revenue is paid directly by patients than in general medicine and cash/blended practices realize $120-$200+ per visit [16]. Costs are mostly labor and occupancy. Three owner lenses — the independent practice's owner cash flow, the franchisor's royalty stream (The Joint collects roughly a 7% royalty plus a 2% marketing-fund contribution on franchised sales), and the private-equity roll-up's buy-low/sell-high multiple arbitrage — all carry over from the child [8][15]. Full mechanics are in Section 5 of the 621310 primer.

6. Demand drivers

Demand is steady and only lightly cyclical: rising consumer use (the National Center for Complementary and Integrative Health reports 11.0% of U.S. adults received chiropractic care in 2022, up from 7.4% in 2002), high and persistent back-and-neck-pain prevalence in an aging, desk-bound population, the structural opioid-alternative shift reflected in the CDC's 2022 pain guideline, and the convenience/cash-pay access that walk-in and membership clinics offer [18][19]. The cash-pay and wellness segment adds a discretionary-spending element that softens in downturns. See Section 6 of the 621310 primer.

7. Regulation

Chiropractic is state-licensed, not federally licensed, and scope of practice varies widely by state — the single most important regulatory variable, because it determines what an office can bill for. Medicare Part B covers only manual spinal manipulation (Chiropractic Manipulative Treatment codes 98940-98942, "AT" modifier required, no maintenance care), a narrow coverage that is a persistent revenue and compliance headwind. Corporate-practice-of-medicine and fee-splitting rules push outside investors into the MSO/PC structure; the FTC Franchise Rule governs the franchise route; HIPAA and the No Surprises Act apply to clinics [20][21]. Full regulatory detail is in Section 7 of the 621310 primer.

8. Consolidation

This is one of the most fragmented industries in the federal data (CR4 of just 1.3% of receipts) [2]. Competition is intensely local. Two forces are slowly consolidating the base: franchising (The Joint's cash-membership model, plus 100% Chiropractic and HealthSource) and MSO / private-equity roll-ups applying the dental-service-organization playbook (e.g., Vistria-backed Chiro One). Consolidation is possible but not automatic — small practices are hard to standardize, many owners are clinically essential, and state corporate-practice rules require doctor-owned clinical entities. Industry observers estimate only about 15-20% of the market is "corporately aligned" today [12][15]. See Section 8 of the 621310 primer.

9. Risks

The material risks carry over from the child: reimbursement compression on the insurance side; discretionary/cyclical exposure of the cash-pay base; regulatory and compliance risk (narrow Medicare coverage, medical-necessity and documentation rules, state scope and corporate-practice limits); clinician dependence (a practice can lose much of its value if the founding DC leaves, and aging solo owners face a succession question); clinical safety and reputation (rare but real adverse events, periodic evidence debates); consolidation-execution risk; cybersecurity/privacy; and, for public investors, single-stock concentration risk in one thinly traded micro-cap. Data limitation: our ground-truth file provides no average revenue per clinic, payer mix, capacity-utilization measure, or nonemployer receipts. See Section 9 of the 621310 primer.

10. How to invest & outlook

Because 62131 equals 621310, the routes are identical. Public: The Joint Corp. (JYNT) is the only direct listed exposure — a micro-cap franchisor whose thesis rests on royalty growth, comparable-clinic sales, refranchising to a capital-light model, and unit expansion; adjacent rehab names (USPH, SEM) are broader businesses, not chiropractic proxies [8][10][20]. Private (where most real exposure lives): own or build a practice, buy a franchise, or invest alongside MSO/PE roll-ups — underwriting normalized owner cash flow, not headline revenue.

Outlook. The demand picture is favorable — rising use, durable opioid-alternative tailwind, and BLS-projected 10% practitioner growth through 2034 — but per-visit reimbursement is likely to stay soft, the cash-pay segment leaves the industry exposed to consumer cycles, and system-wide growth at the visible franchise leader was roughly flat in 2025 [6][10][18][19]. 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 a single small public proxy. For the complete argument, sources, and company detail, read the 621310 primer.

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Sources

Sources are drawn from the child primer (621310), which contains the full 26-entry list. Those cited on this rollup page:

1. U.S. Census Bureau, County Business Patterns 2023 (NAICS 621310 — establishments, employment, annual and Q1 payroll; nonemployer exclusion). 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; HHI suppressed). https://data.census.gov/table/ECNSIZE2022.EC2200SIZECONCEN
3. U.S. Census Bureau, NAICS 2022 — 621310 Offices of Chiropractors (industry definition and exclusions). https://www.census.gov/naics/?details=621310&year=2022
4. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Chiropractors (2024 median pay $79,000; ~57,200 jobs; +10% 2024-34). https://www.bls.gov/ooh/healthcare/chiropractors.htm
5. 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/
6. U.S. Securities and Exchange Commission, The Joint Corp., Form 10-K for the year ended Dec. 31, 2025 (clinic count 960; 7% royalty; 2% marketing fee; CPOM/MSO structure). https://www.sec.gov/Archives/edgar/data/1612630/000161263026000022/jynt-20251231.htm
7. The Joint Corp., FY2025 results / 2026 Letter to Stockholders (company revenue ~$54.9M; system-wide sales ~$532.4M, roughly flat; comparable-clinic sales ~-0.4%), 2026. https://ir.thejoint.com/annual-general-meeting
8. Chiro One / Medulla, company website and The Vistria Group healthcare portfolio listing. https://www.chiroone.com/; https://vistria.com/portfolio_category/healthcare-companies/
9. HealthSource Chiropractic, The HealthSource Story (franchise network, 130-plus owners), 2026. https://www.healthsourcechiro.com/franchise/research/the-healthsource-story/
10. Red Iron Group, Strategic Investment in 100% Chiropractic, 2024; 100% Chiropractic, First Half of 2024 — 125 locations. https://www.prnewswire.com/news-releases/red-iron-group-announces-strategic-investment-in-100-chiropractic-302164167.html
11. CT Acquisitions, Chiropractic Exit / Owner's Guide to Valuation and PE Buyers (~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/
12. Chiropractic Economics, Annual Fees & Reimbursements Survey; ChiroTouch, The State of Chiropractic Billing (cash-pay share 30-50%; ~57% commercial collection), 2022-2024. https://www.chiroeco.com/reimbursements-survey/; https://www.chirotouch.com/article/the-state-of-chiropractic-billing
13. National Center for Complementary and Integrative Health, Spinal Manipulation: What You Need to Know (11.0% of U.S. adults in 2022 vs 7.4% in 2002). https://www.nccih.nih.gov/health/spinal-manipulation-what-you-need-to-know
14. 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
15. Centers for Medicare & Medicaid Services, Medicare Coverage — Chiropractic Services (Part B covers only manual spinal manipulation; CMT codes 98940-98942; AT modifier; no maintenance care). https://www.medicare.gov/coverage/chiropractic-services
16. 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/
17. Federal Trade Commission, A Consumer's Guide to Buying a Franchise (Franchise Rule; FDD; 14-day disclosure), 2020. https://www.ftc.gov/business-guidance/resources/consumers-guide-buying-franchise
18. 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
19. Centers for Medicare & Medicaid Services, No Surprises Act — Know Your Rights Without Insurance, 2024. https://www.cms.gov/medical-bill-rights/know-your-rights/no-insurance
20. U.S. Physical Therapy, Inc., Investor Relations / FAQs (outpatient PT, adjacent to chiropractic), 2026. https://www.usph.com/investor-relations/investor-faqs/
21. U.S. Securities and Exchange Commission, Select Medical Holdings Corp., Form 10-K for the year ended Dec. 31, 2025. https://www.sec.gov/Archives/edgar/data/1320414/000132041426000007/sem-20251231.htm