OBJECTIVES: Musculoskeletal conditions are the primary cause of physical disability in the United States, and have implications for workplace productivity and employer health costs.  This study determined the influence of employer-sponsored, onsite chiropractic care on healthcare utilization. METHODS: A retrospective claims analysis of members of an employer-sponsored health plan receiving chiropractic care exclusively onsite or offsite from 2010-2012.  Data were obtained from the employer’s health benefits administration program.  Eligible participants had continuous enrollment in the health plan and ≥1 billing code for chiropractic services during the 36-month study period.  Utilization was assessed in 2 categories: radiological procedures and clinical care.  Utilization differences were evaluated by having ≥1 healthcare event in any category. Continuous variables were summarized as means, and binary variables as counts and proportions. Differences were assessed via chi-square test for categorical variables and t-test and Kruskal-Wallis non-parametric test for continuous variables. Comparisons were considered significant at alpha = 0.05.  RESULTS: The analysis included 876 onsite and 759 offsite participants.  The populations were similar in gender; the onsite group was slightly younger.  The offsite group received more radiology services overall (55.5% vs 38.2%, P<0.001) including x-ray (46.0% vs 26.6%; P < 0.0001); ultrasound (15.8% vs 10.7%, P<0.0001), and magnetic resonance imaging (14.6% vs 12.4%, P<0.0001); had higher outpatient (47.3% vs 30.2%, P<0.0001) and emergency department (19.0% vs 13.1%; P = 0.022) utilization; and demonstrated greater use of chiropractic care (mean 15.2 vs 9.16 visits; P<0.0001) and physical therapy (mean 9.6 vs 1.5 visits; P<0.0001). CONCLUSIONS: In patients needing chiropractic care, those utilizing onsite services had lower healthcare utilization, including radiology services , clinical care, and counts of chiropractic and physical therapy services. The study results support the value of chiropractic services offered at onsite health centers, where more tightly managed and evidence-based approaches to musculoskeletal conditions can be facilitated.