Licensure List Request

Mailing List Request

Mailing lists are available for a $100.00 fee by following the procedures below. Please fill out this form with your contact information. Then you will be taken to the Mississippi State payment system to make your online payment. Both the form and fee are needed to fulfill the request. You should allow approximately two business weeks for our office to process your request.

*Format: Mailing list information is available through this office as a comma delimited file (spreadsheet). The mailing list will be emailed to the email address you enter below.


Is this list for:	All Chiropractors or In-State Chiropractors
Your Contact Information
*First Name
*Last Name
*Company Name
*Phone
*Email


If you have any questions regarding this form, you may call 662-773-4478.