The NUCCA Certification Program

(Revised June 2014)

**Please note the new certification policy, updated May 2014:

Being a candidate in certification has an emphasis on being engaged in the process or actively participating, therefore you must be actively involved in the certification process to retain a certification candidacy designation on the NUCCA website member listing. If you are currently working on a particular level of certification you have until March 14, 2015 to send in your next submission or your candidacy will be changed to “inactive”.

Dr. Dickholtz Sr analyzing an x-ray NUCCA siteThe NUCCA Certification Program is an integral part of Chiropractic education, training, and development. Becoming proficient in all aspects of x-ray positioning, x-ray analysis, biomechanics, patient evaluation, set up, and adjusting are essential to the reduction of the Atlas Subluxation Complex.

NUCCA seminars are correlatively designed to work in harmony with every aspect of the certification process and where a doctor’s attendance is strongly recommended. By participating in NUCCA seminars and conferences, a doctor is educated and trained by Board Certified NUCCA doctors in the understanding and application of this technique. The Certification Program is designed to create a powerful and effective coaching environment for the doctor and to help them further develop their skills in the “real world” of their practice. The certification process redefines the doctor’s perception of the required accuracy and intricacies of the A.S.C., while honing their skills in the performance of the adjustment.

The NUCCA technique and the Certification Program are often viewed as one of the most difficult and rigorous training programs in Chiropractic. It requires a paradigm shift regarding techniques to understand that it is the complexity of the cervical biomechanics (including regional neurological mechanisms) that are unrelentingly demanding down to the last fraction of a degree. It is being able to effectively apply distinctions developed and taught by NUCCA to the A.S.C. that allow a doctor the easiest, most predictable, and consistent ability to reduce the C-1 subluxation complex.

The doctors that have completed this program and received Board Certification have gained an uncompromised skill in the understanding and correction of the A.S.C.. Through training, a Certified NUCCA Doctor is better able to address the many subtleties associated to the reduction of the A.S.C., versus the management of illusions based in errors and inaccuracies.

The completion of the NUCCA Certification Program is time and effort well spent for the difference that it can make in the life of the doctor and their patients.

NUCCA Certification Board Requirements

(Revised June 2014)

Level I candidates will be tested on their ability to “take” accurate x-rays with excellent image quality. This image must be properly positioned and all structure identification must be clearly seen on all films.

An online exam is required. The standards of this level of certification are that the doctor has knowledge and applicable skills in the following areas:

  • Understanding of x-ray alignment procedures
  • Theory about distortion, magnification and collimation
  • Structural identification on x-ray
  • X-ray filtration
  • Proper x-ray technique and exposures, image quality
  • Patient adjusting steps and purpose of the individual steps
  • NUCCA Historical perspective
  • Use of NUCCA equipment for patient care
  • Leg check and Anatometer procedures
  • Neurological mechanisms of the cervical region
  • Patient positioning for cervical x-rays

A passing grade of 80% is necessary for the online exam.

X-ray Requirements for Candidates in Level I

  • Four views of alignment films. Format can be found in the NUCCA text book and past monographs. X-ray equipment must be aligned to NUCCA standards to participate in all three levels of certification.
  • Five pre-unanalyzed, consecutive sets of patient x-rays demonstrating necessary protocols for patient placement in all three views (Lateral, Nasium, Vertex).
  • Two consecutive sets of both pre and post x-rays, demonstrating necessary protocols for patient placement.

Critical points of consideration include proper exposures, the use of the appropriate filters, proper views of structures, (i.e. posterior arch on the nasal view), and minimal distortions (i.e. rotation and location of structure on the x-ray film).

Any submission provided for review, must be a current submission and the films taken must be within 30 days of the submission date.

Previously reviewed x-rays may not be resubmitted.

After the first set of five pre films have been approved an additional requirement of two consecutive sets of both pre and post x-rays need to be submitted. This set of pre and post films are used exclusively for the criteria of patient placement used in the first five sets of films. These are not evaluated for analysis or reduction of the subluxation.

Once a doctor has completed and passed the online exam, alignment films, five consecutive pre x-rays, two consecutive pre and post films, they are eligible as a candidate for the second level of the NUCCA Board Certification process.

***The fee for candidates to participate in Level I of certification is $350.00 (effective January 1, 2014), and must be submitted to the NUCCA office prior to taking the online exam or submission of x-rays. Once payment is made the NUCCA office will issue a candidate testing username and password along with instructions on how to log onto the testing site. Three exam attempts are allowed per registration fee. Failure to pass the online exam after three attempts will require an additional fee of $50.00 paid to the NUCCA office for a new testing username and password allowing for 2 more attempts.

Click here to purchase Level I Certification online through the store.  The NUCCA office will set up your account to take the online exam and email you the login credentials within 48-72 hours.

Level II candidates will be demonstrating the capability of all level I requirements along with the ability to “analyze” x-rays accurately and consistently.

An online exam is required. The standards in Level II of certification are that the doctor has knowledge and applicable skills in the following areas:

  • Identifying anatomical structures on x-rays for analysis
  • X-ray analysis
  • Advanced adjusting steps
  • Head piece placement
  • Adjusting Biomechanics
  • Understanding basic types
  • Out of pattern subluxations

A passing grade of 80% is necessary for the online exam.

  • Five consecutive sets of pre x-rays including all the necessary requirements of the Level I series including a complete and accurate analysis.
  • Two consecutive sets of pre and post x-rays including all the necessary requirements of the Level I series including a complete and accurate analysis.

Critical points of consideration include identification of all cervical landmarks with appropriate markings, check lines, and listings as per NUCCA protocol.

Any submission provided for review, must be a current submission and the films taken must be within 30 days of the submission date.

Previously reviewed x-rays may not be resubmitted.

Once the doctor has passed the first set of five pre x-rays demonstrating consistently correct placement and analysis, an additional requirement of two consecutive pre and post x-rays are necessary. The pre and post x-ray sets are for positioning and analysis only. These x-rays will not be evaluated for the reduction of the subluxation.

Once the doctor has completed and passed the online exam, five consecutive sets of analyzed pre x-rays, two consecutive analyzed sets of pre and post films, they are eligible as a candidate for the third level of the NUCCA Board Certification process.

***The fee for candidates to participate in Level II of certification is $550.00 (effective January 1, 2014), and must be sent to the NUCCA office prior to taking the online exam or submission of films. Once payment is made the NUCCA office will issue a candidate testing username and password along with instructions on how to log onto the testing site. Three exam attempts are allowed per registration fee. Failure to pass the online exam after three attempts will require an additional fee of $50.00 paid to the NUCCA office for a new testing username and password allowing for 2 more attempts.

Click here to purchase Level II Certification online through the store.  The NUCCA office will set up your account to take the online exam and email you the login credentials within 48-72 hours.

Level III candidates will be required to demonstrate the ability to take x-rays of excellent quality, analyze the x-rays accurately and “reduce” the ASC complex consistently.

The standards of this level of the certification are to bring together all the prior development through Level I and II. The doctor has the opportunity to further refine their x-ray placement and analysis skills while applying this information toward the reduction of the patient’s subluxation.

The x-ray submissions of Level III will require the doctor to maintain the same high standard of x-ray positioning and analysis in Levels I and II. Additionally, the doctor must demonstrate a reduction of the subluxation pattern by 80% or better on the post x-ray. The doctor is also responsible to provide biomechanical explanations about the x-rays that are being submitted.

Biomechanical Questions Regarding the Reduction of the C-1 Subluxation

  1. List the basic type of subluxation and give the characteristics.
  2. How is laterality produced and why that factor is significant?
  3. List the resistances encountered and how to overcome them.
  4. What frontal plain is the lower cervical angular rotation in?
  5. Explain the type of mastoid support to be used and why?
  6. What portion of the mastoid or skull (1) (2) (3) or (4): is placed on the mastoid support areas? (A) (B) (C) or (D). Explain why.
  7. Which headpiece angle will be used in each case?
  8. Did you change the adjusting vector, and if so why?
  9. What aspects of the adjustment do you feel you need to be more conscious of for this subluxation?
  10. Based on your pre and post x-ray findings would you expect the pattern to remain the same or change? Explain.
  11. Based on your pre and post x-ray findings would you change the headpiece placement or the adjusting vector in order to achieve a higher degree of correction?
  12. In comparing your pre and post x-rays, do you feel the patient x-ray placement was accurate? If not, explain.
  13. Based on the pre and post x-ray analysis and the objective findings, when do you think a redo of the pre x-ray is necessary?

The requirements for the submission of consecutive pre and post x-rays for certification review are as follows:

Steps

  • 1 set of pre and post x-rays.
  • 2 consecutive sets of pre and post x-rays.
  • 3 consecutive sets of pre and post x-rays.
  • 4 consecutive sets of pre and post x-rays.
  • 10 consecutive sets of pre and post x-rays to the NUCCA Certification Board.

At some point through this x-ray submission process, reductions of all four types of subluxation patterns must be demonstrated.

Any submission provided for review, must be a current submission and the films taken must be within 30 days of the submission date.

Previously reviewed x-rays may not be resubmitted.

At the completion of this series of x-ray review the doctor will achieve NUCCA Board Certification.

***The fee for candidates to participate in Level III of certification is $1,100.00 (effective January 1, 2014), and must be sent to the NUCCA office prior to submitting films.

Click here to purchase Level III Certification online through the store.

X-ray Submissions for Levels I, II and III are to be submitted to :

Certification candidates in Levels I, II and III can choose one of the following Board Certified doctors to send their x-rays to for review. Once films are submitted do not switch from one reviewer to another.

  • Dr. Irene Adamczuk
  • Dr. Keith Denton
  • Dr. John Dunn
  • Dr. Vince Fitzpatrick
  • Dr. Tym Flory
  • Dr. Michael Foran
  • Dr. Johanna Hoeller
  • Dr. Daiki Ishiyama
  • Dr. Kerry Johnson (digital, Kuhnsoft for analysis)
  • Dr. Craig Lapenski
  • Dr. Steven MacDonald
  • Dr. David Packer
  • Dr. Barbara Read
  • Dr. Deb Sesker
  • Dr. Kurt Sherwood
  • Dr. Jack Stockwell
  • Dr. Lee Yardley (Board Certified Doctors only)
  • Dr. Michael Zabelin (digital only, Viztek for analysis)

The final submission of 10 sets for Board Certification should be sent to one of the following Board Certified Doctors:

  • Dr. Marshall Dickholtz, Jr.
  • Dr. Gordon Hasick

For the purpose of clarity, efficiency, and courtesy all x-ray submissions for any section of certification should include an enclosed letter indicating a request for review and the exact nature of the submission. Example, “enclosed are five sets of x-rays for level one review from XXXXX.” Please do not assume because your x-rays show up in a reviewing doctors office they will know who they are from and what they are for.

Also, please separate the individual sets; a piece of folded paper and a paperclip work well. The reviewing doctors are giving generously of their time, so remember a please and thank you can go a long way. Included with all submissions must be a self-addressed, stamped return envelope.

Certification X-ray Submission Deadlines: All x-rays must be in for review two weeks prior to a NUCCA conference. X-ray submissions will not be reviewed at the conference.

Note:
Only graduate doctors (must be a NUCCA member) are eligible to participate in the certification program. In the event of failure of the examination, or any part thereof, the candidate is re-examined on the part of the examination that is failed without paying an additional fee.

It is advised that a candidate doctor participating in any phase of certification attend a minimum of one NUCCA seminar per year. Doctors who successfully complete the program and are active, will be eligible to qualify as instructors in the NUCCA procedures.

Listing in the NUCCA directory will be as follows:

As doctors complete levels one and two they will be listed as Certification Candidates having completed that specific level of the certification process. Upon completing the third level, the doctor will be listed as NUCCA Board Certified.

If you have completed Level I or Level II of the certification process or Board Certification prior to the conference, you will receive a certificate of completion at the upcoming conference. Doctors not attending the conference will receive their certification via mail.

June 2014 Update to the Certification Program – to maintain active candidacy on the NUCCA website:

Being a candidate in certification has an emphasis on being engaged in the process or actively participating, therefore you must be actively involved in the certification process to retain a certification candidacy designation on the NUCCA website member listing. If you are currently working on a particular level of certification you have until March 14, 2015 to send in your next submission.
For example, if you are:

a. Actively pursuing your next level of candidacy and

b. Currently in between two different levels and

c. Have not submitted and passed a submission since March 2013

You must complete (and pass) that next level of candidacy by March 14, 2015. If you do not complete the next level of candidacy within that period and would like to have your previous level of candidacy remain active, it is necessary to complete the continuing education (CE) requirements of that prior level – click here for additional information.
If you have not yet started your next level of candidacy and would like to enter that phase of your education at this time, it is an acceptable step in this process providing you pass the x-ray portion of that level prior to March 14, 2015 which will keep your prior candidacy level active. Your new certification candidate level will be listed when you have also completed the written examination.

The NUCCA Continuing Education Program

(Updated June 2014)

The Continuing Education Program, being implemented immediately, states that doctors must submit films every 2 years in order to maintain your active candidacy level in the NUCCA directory.

If you are currently listed as an active candidate (including Board Certified Doctors) in the NUCCA directory and haven’t submitted (and passed) a submission since March 1, 2013, YOU MUST TAKE ACTION!

NUCCA Certification Continuing Education Requirements:

x-ray set up NUCCA site1. In order to maintain your active candidacy level on the NUCCA website, you must send in and pass a submission that is congruent with your current candidate level every 2 years. If you have not sent in and passed a submission since March 1, 2013 you must submit films (and pass) by March 14, 2015 in order to maintain your active candidacy.

Continuing education requirements correlate to each individual’s specific candidate or certification level.

*Level one candidates will be required to submit one set of pre and post x-rays with all the required components associated to the successful performance criteria of that level.

*Level two candidates will be required to submit one set of pre and post x-rays fulfilling the requirements associated with their skill level, which involves both taking quality x-rays as well as complete and accurate analysis.

*Level three candidates and board certified doctors will be required to submit one set of x-rays including all components of levels one and two, and an appropriate reduction of the subluxation.

Additional information regarding the requirements for each level of candidacy can be found on the Certification tab of the NUCCA website.

2. The purpose of this change is to maintain a clear and accurate representation of our membership on the NUCCA website to the public. For example; an individual passing a particular level of the certification program 10 years ago and not having provided a current submission of the proficiency of their work, makes it is impossible for the NUCCA organization to make truthful representations to the public via our member directory.

Every two years a member must attend a conference to be considered an active member. Members involved in certification as an advanced learning program, must now also pass a submission at their current level every 2 years to be listed as an “active candidate”. If they do not submit or pass (which they can have multiple opportunities) their candidate level or board certification status will be listed as “inactive”.

3. Any submission provided for review, must be a current submission and the films taken must be within 30 days of the submission date.

4. A current list of reviewing doctors to submit your CE films are listed on the Certification tab of the NUCCA website. There will be no fee to submit your CE films before October 31, 2014. After October 31, 2014, there will be a $100 fee for continuing education submissions. Click here to download the form/checklist that should be sent with your submission.

We look forward to you benefiting through the feedback you will get in this process!

As the NUCCA organization continues to grow, our liability and accountability becomes more important. These changes are implemented in support of a number of current organizational needs:

1. In response to numerous inquiries made to the NUCCA office about the varied experiences the same patient has in different NUCCA offices.

2. To retain the good reputation of our 48-year history that has benefited so many people through a measurable and accurate method of care.

3. The UCRF research results that come from following a standardized protocol of care that is precise and reproducible.

4. To provide the optimal support for advanced learning of the NUCCA procedure.

5. Clear and accurate communication to the public.

6. Chiropractic universities are requesting that we have documented whether a doctors’status within our certification program is active when they appear to teach or speak.

7. Annual or biannual credentialed testing is a common practice and standard of practice among many, if not most, other professional organizations.

Your help and support of these standards will help ensure a healthy future for everyone; patients, practitioners and the NUCCA organization.