Welcome to Chiro-Medical Group's Secure Online Payment Page You can now pay your balance due online. Your payment will be applied to your balance within two business days. Fields marked with an asterisk (*) are required. Patient name * Account number You can locate your account number underneath your name on your monthly statement that you received in the mail. If you are unable to locate your account number, or do not have your monthly statement, you can still make your payment without entering the account number. Billing information First name * Last name * Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP * Email * Phone number * Select payment type * Visa Mastercard Credit card number * Expiration date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025202620272028 CVV/security code * Turn your card over and look at the signature box. You should see either the entire 16-digit credit card number or just the last four digits followed by a special 3-digit code. This 3-digit code is your CVV number / Card Security Code. Payment amount * $