Five credentials, and exactly what each one verifies

There is a list on the US Department of Education’s website that settles more arguments about complementary health care than any amount of debate about whether these practices work.

It is the register of programmatic accrediting agencies the department recognizes, and five of the practices in this section of the library are on it. The accreditors for acupuncture, chiropractic, massage therapy, naturopathy and osteopathic medicine are all there, each with a stated scope. The certifying bodies for reflexology, yoga therapy, dance therapy, Feldenkrais and the Alexander Technique are not. There is no entry for cupping at all.

That line is the spine of this article, and the first thing to say about it is what it does not mean. Federal recognition of an accreditor is a judgment about educational quality assurance, largely for federal student aid purposes. It is not a finding that the practice being taught is effective. Both statements are true at once. The federal government recognizes the body that accredits naturopathic medical schools, and the federal government has made no finding that naturopathic medicine works.

What follows is an inventory. Not advice about checking credentials, which this library covers elsewhere, but the actual degrees, accreditors, examinations and licenses behind five professions, and the specific gaps where there are none.

Five accreditors, named at the recognizing body

Check accreditation claims at the body doing the recognizing, never at the accreditor. Here are the five as the department itself names them, with their recognized scope.

For acupuncture, the Accreditation Commission for Acupuncture and Herbal Medicine, covering professional non-degree and graduate degree programs in the field of acupuncture and Oriental medicine, along with the freestanding institutions that offer them.

For chiropractic, the Council on Chiropractic Education, Commission on Accreditation, covering programs leading to the Doctor of Chiropractic degree.

For massage therapy, the Commission on Massage Therapy Accreditation, covering institutions and programs awarding postsecondary certificates, diplomas and associate degrees in massage therapy, bodywork, and aesthetics and skin care.

For naturopathy, the Council on Naturopathic Medical Education, covering graduate-level, four-year naturopathic medical education programs leading to the Doctor of Naturopathic Medicine or Doctor of Naturopathy.

For osteopathic medicine, the American Osteopathic Association, Commission on Osteopathic College Accreditation, covering freestanding institutions of osteopathic medicine and programs leading to the Doctor of Osteopathy or Doctor of Osteopathic Medicine degree.

Each entry also covers programs offered by distance education, which matters more than it sounds: it means the recognition is about the quality assurance process, not about whether a student ever sat in a room with a patient.

There is a second recognizer in this space, the Council for Higher Education Accreditation, and you will frequently see the two named together as though they always travel in pairs. They do not. The council’s own page for the acupuncture accreditor lists only the Department of Education under the heading of who recognizes it, and refers readers to the department’s site for the recognized scope. Its program listing on that page is dated as accurate to November 2022. Anyone writing that an accreditor is recognized by both bodies needs to check each one separately rather than assume.

The examinations, and who accepts them

An accreditor vets the school. An examination tests the graduate. Those are different gates and the five professions pass through different ones.

Osteopathic physicians sit COMLEX-USA, three levels administered by the National Board of Osteopathic Medical Examiners, taken after the second year, during clinical rotations and during residency. Every one of the 50 states accepts it for licensure. The distinction between an American osteopathic physician and a non-physician osteopath elsewhere in the world is covered in depth in this library’s article on osteopathic approaches, and it is the single most consequential credential distinction in this group.

Chiropractors sit the National Board of Chiropractic Examiners series: three computer-based parts, a practical fourth part, and a physiotherapy examination, with further specialty and state examinations available. By the board’s own account, every state either accepts or requires the first four of those parts as a condition of licensure. It says nothing about what states do with the physiotherapy or specialty papers.

Massage therapists in most jurisdictions sit the MBLEx, administered by the Federation of State Massage Therapy Boards. The federation’s table lists 50 states and territories that regulate the profession, a total made up of 47 states together with the District of Columbia and two territories, Puerto Rico and the Virgin Islands. Forty-six of them accept the MBLEx. Hawaii and New York use their own examination. California and Vermont require no examination.

Naturopathic doctors sit the Naturopathic Physicians Licensing Examination. The examination board’s own state table, revised in September 2025, lists 25 jurisdictions requiring both of its core parts, and carries an unusually candid warning that it cannot guarantee the information is accurate. The examination’s structure, including which parts are optional, is examined in this library’s article on naturopathy.

Acupuncturists sit the certification examinations of the national certification commission for acupuncture. Here the inventory has a genuine hole worth stating: no government body or legislative research office publishes a single tabulation of which states license acupuncture and what each requires, in the way one exists for naturopathy and the way the federation publishes one for massage. The commercial directory sites that dominate search results for that question carry no stated method, no dates and no primary citations, and no count should be taken from them.

What varies across state lines: hours, and who may use the word

The hours

The most useful fact in the massage section is a range. According to a state regulation summary published by a bodywork membership association in September 2024, required education runs from 300 hours for subcategories such as Delaware’s technician certification and Utah’s massage assistant, through 500 hours in more than a dozen states, and topping out at 1,000 hours in Nebraska, in New York and in Puerto Rico.

So the words “licensed massage therapist” denote training that differs by more than threefold between states. And three states, Kansas, Minnesota and Wyoming, have no state massage license; the federation notes that county or municipal ordinances may apply where a state does not regulate. California’s arrangement, where the credential is issued by a private nonprofit that states it is not a state agency, is examined in detail in this library’s article on massage therapy. It is the clearest demonstration available that certified, licensed, state-regulated and title-protected are four different things that come apart.

Correction, October 21, 2026: An earlier version said Minnesota had no state massage regulation at all. Its disclosure-and-complaint law for unlicensed health care practitioners already covered massage, and a statute passed in 2026 lets massage and Asian bodywork therapists register with the state voluntarily. From January 1, 2028, the titles registered massage therapist and registered Asian bodywork therapist belong to registrants; practicing without registering stays legal.

Naturopathy varies in a different dimension. Rather than hours, what changes at the state line is the legal meaning of the credential itself, from a required license with limited prescribing authority in some states, through licensure that is available but not required in others, to three states where the practice is banned outright. That picture, with its sources and dates, is set out in this library’s naturopathy article.

The title

Now the question that decides what a consumer can do about any of it. In a state that does not license a practice, may a person simply use the title?

The default answer is yes. Nothing stops it, unless one of two narrow things is true: a separate statute protects that specific word, or a private trademark reaches the use. Both exceptions exist and both are worth naming, because the general rule is uninformative and the exceptions are where the real mechanisms live.

The statutory example is California’s Massage Therapy Act, which makes it unlawful to advertise using the terms certified massage therapist or certified massage practitioner, or any wording implying certification, without an active certificate from the private council that issues them. The state does not license the practice and does protect the words.

The criminal example is foreign. Under the Osteopaths Act 1993, describing yourself as an osteopath in the United Kingdom without being on the statutory register is a criminal offence carrying a fine, and the regulator enforces it, including through private prosecutions. Five related titles are protected. Nothing in American law resembles this for any practice in this inventory, and that contrast is drawn out in this library’s osteopathic article.

The trademark example is Feldenkrais, which remains a live registered mark enforced by the guild that certifies practitioners. A trademark is enforced in civil court by its owner to protect the mark, not by a regulator on a patient’s behalf, and the difference matters when something goes wrong. The counter-example, from the same shelf of practices, is Pilates, which a federal court held generic in 2000 and ordered cancelled, with the result that anyone may advertise it. This library’s article on movement methods takes both examples further.

For everything else found here, including reflexologist in Washington, where the state’s own page is silent on the point, no title protection was established. Which means the title tells you nothing on its own, and the examination and the license have to do the work.

Two reflexology licenses, and what each one delegates

Reflexology is the best worked example of the gap between holding a license and having been assessed by a state, because two states license it and they do it differently.

Washington writes the standard into rule. Its Department of Health requires a state-approved school or apprenticeship program of at least 200 hours, specified by subject down to five hours on business practice and law and at least 25 hours of supervised practicum. Then it borrows the knowledge test: applicants must pass the written examination of the American Reflexology Certification Board, a private organization, plus a state jurisprudence examination on Washington law.

New Hampshire delegates everything. Its board of reflexologists, structural integrators and Asian bodywork therapists, inside the Office of Professional Licensure and Certification, asks for a current certificate from a national certifying agency approved by the commissioner, and names that private board for reflexologists. The state sets no training hours. The state sets no examination; whatever the national certifier requires is what counts. Reciprocity is not accepted. The fee, and the rest of the reflexology picture, sits in this library’s article on that practice.

Both are real licenses with real legal effect. In the four-bucket framework used across this library, both sit in the first bucket, written into regulation, with the substantive competence standard handed to a private third-party certifier in the third. Washington keeps the floor and outsources the test. New Hampshire outsources both.

Note what that means for a complaint. A grievance about a practitioner failing the state’s own standard goes to a state board with powers. A grievance about the standard itself goes to a membership organization with none.

The practices no state licenses

For a large part of this field the honest answer is that no credential exists, and unlicensed is not one condition. It is at least four, and which one applies determines what a consumer can check.

Energy work is unlicensed by explicit legislative choice in at least one state. New Hampshire’s massage chapter contains an exemption provision that names polarity therapy, therapeutic touch, Bowen therapy and reiki, carving them out of massage licensure provided their services are not presented as massage. The statute creates no title protection and prohibits nothing. It names these practices in order to place them outside the license.

Yoga therapy has a private credential and, since 2023, an examination behind it. The International Association of Yoga Therapists grants the C-IAYT credential to members who graduate from programs it accredits. Its certification background page records two dates: the examination became required of portfolio applicants from March 1, 2023, and of students who enrolled in one of its accredited programs on or after July 1, 2023. Its own eligibility page still describes that examination as in beta testing from late 2021 and not yet required, which is a reminder to check more than one page on an organization’s own site. The association does not appear on the federal accreditor list, and neither page addresses state licensing, because there is none.

Cupping has nothing. No license in any state, no national certification board, no accreditor on the federal list. In practice it is performed under other professions’ licenses, which makes the scope-of-practice question specific to the practitioner’s own board. This library’s cupping article covers why that matters most for the wet version of the procedure, which deliberately breaks skin.

Where you can look somebody up

For physicians there is one place. The Federation of State Medical Boards operates DocInfo, which the federation describes as a free search tool covering physicians and physician assistants, carrying licensure and disciplinary information supplied by medical boards. One search, nationwide, with discipline attached.

For the other four modalities there is no equivalent. No national aggregator for chiropractors, acupuncturists, massage therapists, naturopaths or reflexologists surfaced in researching this article. That absence is itself the finding, and it is the practical difference between checking a doctor and checking everyone else: for physicians you look in one place, and for the rest you have to find the right state board first.

Even inside a single state the entry points differ. California’s Department of Consumer Affairs publishes a consumer guide listing the health professions its entities license, and the list runs past thirty entries, including acupuncturists, chiropractors, naturopathic doctors and osteopathic physicians. Massage therapists are not on it, because they go through a separate private council. The department says you can verify the license of any professional it licenses through its website, and that the information available to the public may include disciplinary action taken against license holders.

Some boards go further than a status check. The California Acupuncture Board publishes the actual documents. Individual accusations, statements of issues, stipulated settlements and decisions sit as PDFs on the board’s own site, filed under case numbers and dates; one verified example is an accusation in case 1A-2011-103, filed on 12 April 2012. That is a different and much more informative thing than a line saying a license is active.

What is not established is whether every state board for every one of these five professions publishes disciplinary documents, or whether any of it is searchable in one place for non-physicians. Nothing here supports that generalisation, and nothing supports a claim about how widespread unlicensed practice is in this country either, since no enforcement counts could be found for any of these modalities.

The safety question changes with the modality

Generic safety advice is worth less than the specific question each practice’s own adverse-event record generates.

For acupuncture, the record points at one thing. A systematic review of case reports published between 2000 and 2011 collected 308 adverse events from 117 published reports in 25 countries and regions, and concluded that infection was the main complication, with most cases bacterial and arising from skin contact at needling sites rather than from the needles themselves. The authors’ prescription is the consumer’s question: whether the practitioner follows Clean Needle Technique and uses single-use sterile needles disposed of after one patient. This library’s acupuncture article carries the fuller harm record.

For chiropractic and other spinal manipulation, the question is whether manipulation of the neck is planned and whether an alternative exists. The quantified signal available here comes from a 2024 review of manipulation for migraine, which pooled two trials and found a risk ratio for adverse events of 2.06, interval 1.24 to 3.41. That works out at one extra adverse event for every six people treated, on very low certainty evidence. The specific question of neck manipulation and artery tears belongs to this library’s spinal manipulation article, which treats it properly.

For naturopathy, the question is whether anything recommended will be taken alongside a prescribed medicine, who is checking for interactions, and whether the practitioner holds prescribing authority in that state at all.

For massage, the questions are practical: what the practitioner’s actual training was in a 300-hour state or an unregulated one, and whether they have been told about anticoagulation, recent surgery, clotting risk or fragile skin.

For anything involving cupping, the question is dry or wet, because the second one withdraws blood.

What to check, in order

Four steps, cheapest first.

Start with the credential’s own gate. Ask which examination the person passed and who administers it. Four of these five professions have a national examination accepted or required in every state or nearly all of them. If the answer is a certificate with no examination behind it, that is not a scandal, but it is a different kind of object and should be priced accordingly.

Then check the license where one exists, at the state board rather than at a directory, and at DocInfo if the person is a physician or a PA.

Then ask what the state assessed. Two states license reflexologists and neither tests them itself. One large state does not license massage therapists at all. A license proves a box was ticked; it does not prove who ticked it.

Then ask the modality’s own safety question from the list above, and get an answer in specifics rather than reassurance.

The single most useful thing in this whole inventory is the federal list in the opening. If a practice has an accreditor on it, there is an auditable chain from the school through the examination to a state license, and you can walk it. If it does not, the credential is whatever the organization issuing it decided it should be, and the only way to know what that is, is to read their requirements yourself.

Sources

1. US Department of Education. “Programmatic Accrediting Agencies.” ed.gov
2. Council for Higher Education Accreditation. “Accreditation Commission for Acupuncture and Herbal Medicine directory entry (lists only USDE under Recognized by; program listings accurate as of November 2022).” chea.org
3. American Association of Colleges of Osteopathic Medicine. “Board Examinations and Licensure.” aacom.org
4. National Board of Chiropractic Examiners. “About NBCE (all 50 states accept or require Parts I, II, III and IV for licensure).” nbce.org
5. Federation of State Massage Therapy Boards. “Regulated States (50 states and territories; 46 accept the MBLEx; published 16 November 2023, last modified 18 June 2026).” fsmtb.org
6. Associated Bodywork and Massage Professionals. “State Regulation Card, last updated September 2024 (education hours 300 to 1,000; Kansas, Minnesota and Wyoming unregulated).” ten.abmp.com
7. North American Board of Naturopathic Examiners. “State and Provincial Requirements, revised September 2025 (25 US jurisdictions listed; board states it cannot guarantee accuracy).”
8. Connecticut General Assembly, Office of Legislative Research. “Dube N. "Naturopath Licensing and Prescriptive Authority in Other States," report 2023-R-0240, 4 October 2023.” prdext3.cga.ct.gov
9. Washington State Department of Health. “Reflexologist Certification Requirements (RCW 18.108.070; WAC 246-831).” doh.wa.gov
10. New Hampshire Employment Security, Economic and Labor Market Information Bureau. “Licensed, Certified, and Registered Occupations in New Hampshire 2021: Reflexologist.” nhes.nh.gov
11. New Hampshire General Court. “RSA 328-B:10, Massage Therapists and Massage Establishments: Exemptions; Application of Chapter.” gc.nh.gov
12. International Association of Yoga Therapists. “Certification Background and Future (C-IAYT; examination required of PR and E portfolio applicants from 1 March 2023 and of accredited-program students enrolling on or after 1 July 2023).” iayt.org
13. International Association of Yoga Therapists. “Certification Eligibility (page not updated: still describes the examination as in beta testing from late 2021 and not yet required).” iayt.org
14. Federation of State Medical Boards. “Member Resources (DocInfo described as a free physician and PA search tool including licensure and disciplinary information).” fsmb.org
15. California Department of Consumer Affairs. “Licensed Health Professionals and Verify a License.” dca.ca.gov
16. California Acupuncture Board, Department of Consumer Affairs. “Accusation, case 1A-2011-103, filed 12 April 2012 (example of an individual disciplinary document published by a non-physician state board).” acupuncture.ca.gov
17. California Senate Committee on Business, Professions and Economic Development and Assembly Committee on Business and Professions. “Background Paper, California Massage Therapy Council sunset review oversight hearing, 9 March 2021.” sbp.senate.ca.gov
18. The National Archives (legislation.gov.uk). “Osteopaths Act 1993, section 32: Offences.” legislation.gov.uk
19. Stites and Harbison PLLC (Trademarkology). “Pilates: A Deep Stretch of Trademark Law (S.D.N.Y. 2000, Cedarbaum J.; USPTO directed to cancel the marks).” stites.com
20. Feldenkrais Guild of North America. “GCFP Certification policy E2.3.1.1, adopted October 1997, last revised 27 January 2025.” cdn.ymaws.com
21. Evidence-Based Complementary and Alternative Medicine. “Xu S, Wang L, Cooper E, Zhang M, Manheimer E, Berman B, Shen X, Lao L. "Adverse events of acupuncture: a systematic review of case reports." Evid Based Complement Alternat Med, 2013. PubMed. DOI: 10.1155/2013/581203.” pubmed.ncbi.nlm.nih.gov
22. Systematic Reviews. “Posadzki P, Klimek AT, Ernst E. "Spinal manipulations for migraine: an updated systematic review and meta-analysis of randomized clinical trials." Syst Rev, 2024. PubMed. DOI: 10.1186/s13643-024-02719-6.” pubmed.ncbi.nlm.nih.gov