Chiropractic Practice Marketing Kit

SKILL.md

# Chiropractic Practice Marketing Kit v1.0

**Version:** 1.0.0
**Category:** Marketing / Healthcare / Local Business
**Compliance Jurisdiction:** Nevada (Clark County primary) — principles transferable nationwide
**Last Updated:** 2026-05-27

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## What This Skill Does

Generates complete, compliance-audited marketing content for Nevada chiropractic practices. Every output is screened against 7 compliance moats that national marketing tools miss entirely — protecting DCs from Nevada Chiropractic Board sanctions, FTC enforcement, HIPAA breaches, Medicare overpayment audits, credential misrepresentation claims, and personal injury advertising violations.

Chiropractic practices sit at a uniquely complex regulatory intersection: scope-of-practice law (NRS 634) defines what a chiropractor can and cannot do or claim, Medicare has strict coverage rules that differ sharply from what most patients expect, FTC 2023 testimonial rules block the most common patient success story language, and Nevada-specific personal injury lien advertising has disclosure requirements most chiropractic marketing ignores entirely. Generic AI marketing tools generate all of these violations automatically.

**Outputs per run:**
- New patient acquisition campaigns: seasonal email (3 variants), Google RSA ad groups (5), FB/IG ad briefs (6), SMS campaigns (4), GBP posts (4)
- Service pages with FAQ + JSON-LD schema markup (6 specialty pages)
- Reputation management: review request sequences, GBP response templates (15), B2B referral letters (6)
- Digital ads + local SEO: LSA checklist, keyword clusters (30), TikTok calendar (30 days), GBP calendar (30 days)

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## The 7 Compliance Moats

### Moat 1 — Nevada NRS 634 Scope of Practice & Title Gate [ANCHOR]
**What it blocks:** "Chiropractic physician," "physician," "chiropractic specialist," "chiropractic medicine," claims of diagnosing systemic disease, prescribing medications, performing surgery, treating cancer, or any practice outside the statutory definition of chiropractic in Nevada Revised Statutes Chapter 634.

**The standard:**
- **NRS 634.013 — Definition of chiropractic in Nevada:** "Chiropractic" means the diagnosing and locating of misaligned or displaced vertebrae and articulations, and the treatment thereof, by manipulation and adjustment of the spine, vertebral column, and its immediate muscles, tissues, and ligaments. Nevada chiropractors may also diagnose and treat conditions of the musculoskeletal system and related conditions.
- **What Nevada DCs cannot do:** Prescribe medications (NRS 634 does not grant prescriptive authority — unlike Oregon, New Mexico, or some other states); perform surgery; hold out as a "physician" without the qualifier "chiropractic" attached; claim to treat systemic diseases (diabetes, hypertension, cancer) through spinal adjustment alone.
- **Title rules:** In Nevada, a licensed chiropractor may use "Doctor of Chiropractic" or "D.C." — not "Dr. [Name], Physician" without the chiropractic qualifier. "Chiropractic physician" is used in marketing but not legally designated in Nevada statutes (unlike California, which does authorize the term).
- **NRS 634.014 — Scope expansion:** Nevada DCs may use physiotherapy modalities (ultrasound, TENS, EMS, cold laser) as adjuncts to chiropractic adjustment but may not hold out physiotherapy as the primary service or use it without an active chiropractic diagnosis and treatment plan.
- **Subluxation vs. medical diagnosis:** A "vertebral subluxation complex" is a chiropractic term — not a recognized ICD-10 medical diagnosis. Marketing that uses subluxation language is legally chiropractic scope; marketing that conflates adjustment with medical diagnosis (e.g., "our adjustments treat disc herniation — confirmed by MRI") ventures into unauthorized medical practice.

**What this gate blocks permanently:**
- "Dr. [Name], Physician" standalone without "chiropractic" qualifier
- "Chiropractic medicine" (medicine = prescriptive authority DC does not have in Nevada)
- "We treat disc herniation, sciatica, and scoliosis" (treatment claims for named medical diagnoses without noting chiropractic scope)
- "Spinal adjustments cure diabetes / regulate blood pressure / treat autoimmune disease" (systemic disease cure claims unsupported by evidence and outside chiropractic scope)
- "We can treat your sports injury with the same techniques used by orthopedic surgeons" (surgical scope conflation)

**What this gate outputs instead:** "Dr. [Name], Doctor of Chiropractic (D.C.)," "chiropractic care for back pain, neck pain, and musculoskeletal conditions," "spinal adjustment and physiotherapy modalities," "supporting your body's natural musculoskeletal health."

**Why competitors miss it:** NRS 634 scope definitions are Nevada-specific statutory law — not HIPAA or federal regulation — so they fall outside national AI marketing tool training. The title/scope line between "chiropractic physician" (marketing convention) and what NRS 634 actually authorizes is subtle enough that most human writers miss it too.

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### Moat 2 — Nevada Chiropractic Board Advertising Rule Gate (NAC 634)
**What it blocks:** False, deceptive, or misleading advertising claims; unsubstantiated outcome guarantees; advertising that implies NVBCE endorsement or state licensing as a quality signal; "best chiropractor" superlatives without substantiation; misleading before/after claims; advertising foreign credentials without disclosing Nevada licensure status.

**The standard:**
- **NAC 634.445 — Nevada Chiropractic Board advertising rules:** A chiropractor shall not use advertising that is false, deceptive, or misleading. Includes: claims that cannot be substantiated, claims implying unique capabilities without basis, testimonials that do not reflect typical results.
- **NAC 634.450 — Credential advertising:** A chiropractor advertising a specialty certification must hold the certification as currently active and in good standing. The certifying body must be identified. "Board certified" without the certifying board named = misleading under NAC 634.450.
- **NVBCE complaint mechanism:** The Nevada Board of Chiropractic Examiners actively investigates advertising complaints. Competitor-initiated complaints are a documented enforcement pathway, the same as with NSBD (dental) and NBOE (optometry).

**What this gate blocks permanently:**
- "Nevada's #1 chiropractor" without objective substantiation
- "Board certified" without naming the certifying organization (CCSP/CCEP/DACNB/FICC — see Moat 6)
- "We guarantee pain relief in X visits" (unsubstantiated outcome guarantee)
- "State-licensed and approved" as a quality signal (licensing = baseline requirement, not an endorsement)
- "Our technique is the most effective chiropractic method available" (superiority claim without substantiation)

**What this gate outputs instead:** "NVBCE-licensed Doctor of Chiropractic since [year]," "CCSP-certified, [certifying board] (see Moat 6)," "most patients report improvement — individual results vary," "one of Henderson's highly-reviewed chiropractic practices."

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### Moat 3 — FTC 2023 Testimonial & Outcome Claim Gate (16 CFR Part 255)
**What it blocks:** Patient testimonials claiming complete cures, permanent elimination of chronic conditions, outcomes that are not typical without disclosure, and any claim that would require substantiation the practice cannot provide.

**The standard:**
- **16 CFR Part 255 — FTC Endorsement and Testimonial Guides (revised October 2023):** Testimonials advertising a product or service must reflect typical consumer experience, or the ad must clearly disclose what the typical outcome is. "Results not typical" is no longer sufficient — the advertiser must disclose what the typical outcome actually is.
- **Health outcome claims:** "Cured my herniated disc," "eliminated my sciatica permanently," "fixed my scoliosis in 6 weeks," "I haven't taken pain medication in 3 years thanks to Dr. [Name]" — these are outcome claims that imply chiropractic can produce these results for the typical patient. If they are not typical, the ad must state what typical results look like.
- **Before/after in chiropractic:** Posture photos, X-ray comparisons (pre/post treatment), pain scale reductions shown as testimonials — all subject to FTC 2023 rules. The claim implied (this is what chiropractic treatment produces) must be substantiated.
- **Social media and Google reviews:** The FTC 2023 updates extended to reviews solicited by the business. Offering a discount, free visit, or gift card for a review = endorsement subject to FTC rules. "Leave us a Google review after your visit" (unprompted) = acceptable. "Leave us a 5-star review and get 10% off your next visit" = FTC violation.

**What this gate blocks permanently:**
- "Chiropractic cured my chronic back pain — I've been pain-free for 5 years" (without typical results disclosure)
- "After 8 visits, my herniated disc was gone — confirmed by MRI" (extraordinary medical claim presented as testimonial)
- "I went from a wheelchair to playing golf thanks to Dr. [Name]" (exceptional outcome without typical results context)
- "Get 10% off your next visit for leaving a Google review" (incentivized review = FTC violation)
- Before/after X-ray comparisons implying typical patient outcome

**What this gate outputs instead:** "Many patients report significant improvement in back and neck pain — individual results vary based on condition, severity, and treatment frequency," "hear what our patients say about their experience — visit [review platform]," "5-star rated on Google by [N] patients."

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### Moat 4 — HIPAA PHI & Marketing Authorization Gate (45 CFR §164.508)
**What it blocks:** Patient success stories, testimonials, or case studies that include identifiable health information without a properly executed HIPAA marketing authorization — separate from the general treatment consent form.

**The standard:**
- **45 CFR §164.508 — Authorization for uses and disclosures:** Any use of PHI for marketing purposes requires a specific written authorization that is separate from the general consent to treatment. PHI includes not only name + diagnosis, but any information that could reasonably identify an individual combined with health information — including a photo of a patient at a chiropractic practice.
- **What constitutes PHI in chiropractic marketing:** "John, a 45-year-old construction worker with L4-L5 disc herniation, saw relief after 12 visits" = PHI. "A Henderson patient with lower back pain" is generally acceptable (de-identified). A photo of a recognizable patient in the office = PHI. A "before" posture photo + "after" posture photo with the patient's face visible = PHI.
- **Marketing authorization requirements (45 CFR §164.508(b)(3)):** Must describe the PHI to be disclosed, the purpose of the marketing, whether the covered entity receives remuneration for the marketing, and the patient's right to revoke authorization. General consent to treatment does NOT cover marketing.
- **OCR enforcement:** OCR has pursued HIPAA enforcement actions against healthcare providers for testimonial-based marketing that used patient PHI without proper authorization. Penalties range from $100 to $50,000+ per violation.

**What this gate blocks permanently:**
- Patient testimonials with name + condition in the same content piece (without marketing authorization)
- Before/after posture or X-ray photos with identifiable patient features (face, distinctive physical characteristics)
- Case studies with specific injury history and treatment outcome that could identify an individual
- Video testimonials posted to social media without HIPAA marketing authorization
- Staff celebrating patient milestones (e.g., "Congratulations to [Patient Name] on completing their 24-visit plan!") on social media

**What this gate outputs instead:** Authorization language, de-identified testimonial format ("a patient in their 40s with chronic neck pain reported improvement after 8 visits — individual results vary"), and first-name-only with explicit marketing authorization documented.

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### Moat 5 — Medicare Chiropractic Coverage Accuracy Gate
**What it blocks:** "Medicare accepted" or "we take Medicare" language that implies Medicare covers the full scope of chiropractic services — when Medicare Part B covers only one specific service and excludes nearly everything else chiropractic practices offer.

**The standard:**
- **Medicare Part B chiropractic coverage:** Medicare Part B covers ONLY manual manipulation of the spine (CPT 98940, 98941, 98942) to correct a subluxation demonstrated to be causing a neuromusculoskeletal condition. This is the sole covered chiropractic benefit.
- **What Medicare does NOT cover for chiropractic:** Massage therapy, acupuncture, TENS/EMS therapy, ultrasound, cold laser, orthotics/shoe inserts, X-rays ordered by chiropractors (not covered as a standalone chiropractic benefit — must be ordered by a physician for Medicare Part B), maintenance care (once patient has reached maximum therapeutic benefit, Medicare considers ongoing adjustments non-covered maintenance).
- **OIG compliance history:** The OIG has specifically identified chiropractic billing for maintenance care as a high-risk area. OIG audit findings have resulted in significant Medicare recoupment actions against chiropractic practices that billed adjustments as "active treatment" after the patient reached maximum therapeutic benefit.
- **ABN requirement:** When a chiropractor believes Medicare will not cover a service, they must provide the patient an Advance Beneficiary Notice of Noncoverage (ABN) before the service. Failing to provide an ABN when coverage is in question = potential Medicare fraud.

**What this gate blocks permanently:**
- "Medicare accepted — we cover everything" (Medicare covers one CPT code category)
- "Free Medicare annual wellness exam" (routine wellness exams at chiropractic offices are not a Medicare Part B benefit)
- "We bill Medicare for your massage therapy and orthotics" (non-covered services)
- "Maintenance adjustments covered by Medicare" (maintenance care = non-covered)
- X-ray promotional language implying Medicare covers chiropractic-ordered X-rays

**What this gate outputs instead:** "Medicare Part B covers spinal manipulation for active musculoskeletal conditions — ask our billing team about your specific coverage," "we're Medicare-enrolled and handle your billing for covered services," "some services may require out-of-pocket payment — we'll explain your coverage before treatment."

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### Moat 6 — Chiropractic Credential Accuracy Gate (CCSP / CCEP / DACNB / FICC)
**What it blocks:** "Board certified," "fellowship trained," "specialty certified," or "advanced training" claims without specifying the actual certifying organization and verifying the credential is currently active.

**The standard:**
- **Real post-doctoral chiropractic credentials recognized in Nevada:**
  - **CCSP** — Certified Chiropractic Sports Physician® (American Chiropractic Board of Sports Physicians / ACBSP) — requires post-doctoral sports injury training and board examination
  - **CCEP** — Certified Chiropractic Extremity Practitioner (American Chiropractic Extremity Practitioners / ACEP) — extremity adjusting specialist certification
  - **DACNB** — Diplomate of the American Chiropractic Neurology Board (ACNB) — functional neurology specialty
  - **DACO** — Diplomate, American Chiropractic Orthopedists (ACCO)
  - **FICC** — Fellow of the International College of Chiropractors
  - **ART® (Active Release Techniques®)** — provider certification from ART, LLC; must be current and sport/area-specific (full body, upper extremity, lower extremity, spine)
  - **Webster Technique Certification** — from International Chiropractic Pediatric Association (ICPA); specific to sacral analysis for pregnant patients
- **What is not a real chiropractic specialty credential:** "Chiropractic specialist" (no such NVBCE credential), "chiropractic physician" (not a credential — a title debate), "certified in [technique name]" without naming the certifying body.
- **Credential verification requirement:** NVBCE requires that advertised credentials be currently active. A lapsed CCSP (renewal required every 3 years) advertised as current = NAC 634.450 violation.

**What this gate blocks permanently:**
- "Board certified chiropractor" without naming the board (ACBSP, ACNB, ACCO, etc.)
- "Fellowship trained" without specifying the fellowship (FICC, etc.)
- "Certified in sports chiropractic" without naming CCSP from ACBSP
- "Pediatric chiropractic specialist" without Webster Technique Certification from ICPA
- "ART certified" without confirming current ART certification level and area(s)
- "Dry needling specialist" — Nevada law on DC dry needling is not settled; requires explicit legal verification before advertising

**What this gate outputs instead:** "CCSP® — Certified Chiropractic Sports Physician® (American Chiropractic Board of Sports Physicians)," "ART® Full Body certified provider (Active Release Techniques® LLC)," "Webster Technique certified (ICPA) for prenatal chiropractic care," "DACNB — Diplomate of the American Chiropractic Neurology Board."

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### Moat 7 — Nevada Personal Injury & Workers' Comp Lien Advertising Gate
**What it blocks:** Personal injury lien advertising language that creates misleading impressions about fee structures, attorney relationships, settlement guarantees, or liability — a major segment of Nevada chiropractic marketing around auto accidents and work injuries.

**The standard:**
- **Nevada chiropractic PI lien practice:** A large percentage of Clark County chiropractic practices derive significant revenue from auto accident personal injury cases billed on a lien basis (payment deferred until settlement). This generates a specific category of advertising ("we accept accident cases," "no upfront cost," "we'll wait for your settlement").
- **Nevada NRS 7 (attorney-client / referral fee rules) interaction:** Attorneys may not pay chiropractors for patient referrals; chiropractors may not pay attorneys for case referrals. Direct advertising that implies a referral relationship with specific PI attorneys can create NRS 7 exposure for both parties.
- **Nevada Insurance Division oversight:** Workers' compensation chiropractic advertising is subject to Nevada workers' comp billing regulations. "We accept workers' comp — no out-of-pocket cost" is largely accurate but creates expectations that must be managed (employer must have filed a valid claim, insurer must authorize treatment).
- **FTC consumer protection overlap:** "No upfront cost — we'll wait for your settlement" without disclosing that the lien attaches to the settlement proceeds, that lien amounts may reduce the patient's net recovery, or that the patient may owe the balance if the case settles for less than the lien value = potentially deceptive under FTC Act §5.
- **OIG / anti-kickback:** Federal anti-kickback statute (42 USC §1320a-7b) applies where Medicare/Medicaid patients are involved in PI cases. Waiving copays for PI patients to increase referrals = OIG exposure.

**What this gate blocks permanently:**
- "We work directly with your attorney — no cost to you" (implies financial arrangement with attorney)
- "Guaranteed no out-of-pocket — your settlement will cover everything" (settlement outcome guarantee)
- "Sign here and we'll handle everything with your lawyer" (creates legal relationship expectations)
- "We accept all work injury cases — Workers' Comp always covers chiropractic" (Workers' Comp authorization is required and not automatic)
- Waiving Medicare/Medicaid copays for PI patients as a marketing incentive

**What this gate outputs instead:** "We accept personal injury cases on a lien basis — our billing team will explain how lien-based care works before your first visit," "we work with your insurance carrier for workers' compensation claims — authorization required," "questions about auto accident care? Call our billing coordinator at [phone] for a free insurance review."

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## Pricing

| Tier | Price | What You Get |
|------|-------|-------------|
| One-time | $49 | Lifetime access to all 4 prompts + example |
| Monthly | $19.99/month | Access + updates as Nevada regulations change |
| Healthcare Bundle | $99 | This skill + 70+ healthcare/professional practice marketing skills |

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## Related Skills
- Optometry & Eye Care Marketing Kit (#228) — FTC Contact Lens Rule, FDA device gate, NRS 636
- Dental Practice Marketing Kit (#229) — NSBD specialty gate, NRS 631.220, CDT codes
- Physical Therapy & Rehab Marketing Kit — PT board scope, Medicare therapy caps
- Medical Spa / Medspa Marketing Kit — Nevada SB 306 delegation gate, laser safety
- Veterinary Practice Marketing Kit — Nevada VSMEB scope, FTC health claims

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## Who This Is For
- Clark County / Las Vegas chiropractic practice owners
- Chiropractic practice managers and front desk coordinators handling marketing
- Healthcare marketing agencies serving chiropractic clients
- Franchise chiropractic networks standardizing compliant marketing across locations (The Joint, Chiro One, etc.)
- Personal injury chiropractic practices needing PI-specific compliant advertising language