There are limited data on chiropractic care for older adults, specifically from medically underserved communities. This study describes the characteristics, clinical management, and patient-reported outcomes of older adults with spinal pain who present for chiropractic care at a publicly funded community health centre serving marginalized populations. This retrospective analysis utilized quality assurance data from chiropractic encounters at Mount Carmel Clinic between January 2011 and June 2020 of adults aged 45 and older. Descriptive statistics summarized the study population and their self-reported pain severity scores. Student’s t-tests and repeated-measures ANOVA explored relationships between pain outcomes, age, and clinical characteristics. The sample included 240 middle-aged (45–59 years) and older adults (≥60 years) who recorded baseline and discharge pain scores following chiropractic treatment. Over half of middle-aged participants self-identified as Indigenous or as people with disabilities. Statistically and clinically important improvements in pain were noted across spinal regions and extremities for both cohorts.