Changing Your Legal Name
Whom do I need to notify if I change my legal (individual given) name? How do I have my chiropractic physician name changed of record?
A holder of a chiropractic license must notify the Illinois Department of Financial and Professional Regulation (IDFPR) on a printed form if the licensee changes his/her legal name by marriage, court order, or dissolution of marriage. Unlike a change of street address, email address, or telephone number, a change of name CANNOT be completed online. If your name has changed, you must submit a written notice to the Department and include documentation of the name change (marriage license, court order, or divorce decree).
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For a copy of the name change form, please click here. You will need to fill in your current contact information and name change information. (Note that the form is titled “Name and Address Change Form,” as some licensees who do not use the online process for address change will use this form. You may omit the address change information if it is not applicable.)
After filling out the form, it is to be submitted to the Department either:
- Via email to fpr.lmu@illinois.gov OR
- Via regular mail to: Illinois Department of Financial and Professional Regulation, Division of Professional Regulation, 320 W. Washington Street, Springfield, IL 62786.
The ICS strongly recommends that you send the form in a manner that shows confirmation of delivery.
Licensees should also notify any health networks with whom they participate and liability insurers (malpractice and general liability) according to terms spelled out in their provider agreements and insurance policies.
If you change your legal name but would like to keep your practice under your previous name, you would need to establish an assumed business name (a practice name that does not include the legal name of the individual owner). For information concerning how to practice under an assumed business name, please see the Assumed Business Names article.
