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Address Change Form
N.J.A.C. 13:45C-1.3(a)7 requires that all New Jersey licensees provide a timely notice of any change of address from that which appears on the licensee's most recent license renewal or application.
If your MAILING ADDRESS is not current, you will not receive your license renewal form or any other Board mailings. To ensure that you will receive all Board mailings you must immediately send the Board your current address information.
The Division is precluded by law from disclosing to the public the place of residence of licensees or applicants, without their consent. You are, however, required to provide an address that may be released to the public in our directories or in response to other requests. If you provide only your place of residence as your public address of record, we will assume that you have consented to have that address be disclosed. If you do not consent to the disclosure of your place of residence, use this form to provide an address of record other than your place of residence that may be released to the public.
An address of record may be a post office box address, only if another address with a street address is provided. If you do not indicate an address of record, we will assume that you have converted to the use of your mailing address as your address of record.
This change of address form may be completed and submitted electronically by clicking the "Submit the Form" button below to meet the address reporting requirement. This form is for address change reporting only.
Licenses Are Not Forwarded
by the Postal Service to a Forwarding Address
* = required fields
Is this your address of record?
If you have made a legal name change it is imperative that this legal name change be reported immediately to the State Board of Chiropractic Examiners. You must mail the following items to the Board office c/o Professional Board Consumer Service Center, PO Box 45046, Newark, New Jersey 07101.
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