The practice of chiropractic in the United States, is limited to holders of a Doctor of Chiropractic (D.C.) degree from a college accredited by the Council on Chiropractic Education (CCE), an agency certified by the U.S. Department of Education to accredit chiropractic colleges in the United States. Chiropractic training is a 4-year academic program that includes both classroom work and direct experience caring for patients. Coursework includes instruction in the biomedical sciences, as well as in public health and research methods. Currently, there are four National Board examinations required for licensing in most states, in addition to annual requirements of continuing education credits.