To Rank a Website With Keywords of Chiropractor in the City or Any Location

Capo
I need help.
I'm struggling to rank the different city pages for my wife's chiropractic website. She has an office in one city, but since it's very small and surrounded by others, we're trying to get her to show up in the other city pages as well.
Current strategies implemented:

URL STRUCTURE: domain/california/city-chiropractor
LINKS: Built Relevant, non-spammy guest post links to the 'california' silo page, and to the individual city pages.
CONTENT: All city pages have unique content ranging from 1500-2500 (I tested different content lengths to see if it made a difference).
SUPPORTING CONTENT: Some city pages have supporting, smaller blogs as 'clusters' pointing back to them. This ranges from 5-15 supporting blogs, with internal links pointing back to the city pages.
INTERNAL LINKS: The city pages are linked from the Navigation Bar of the website to give them extra juice. Some city pages are also linked from the content of the homepage (didn't do all of them to test if it made a difference or not).
SCHEMA: Unique, local schema markup for each city page.
WEBSITE SPEED: A-rating on GTmetrix
Ahrefs Domain Rating (DR): 39 according to Ahrefs – built through citations, guest posting, and Help a Reporter Out (HARO)
ON-PAGE SEO: Geotagged photos for each city, keyword in alt text, some city pages have a YouTube video from the company channel with the keyword in the title of the video

Where am I screwing up?! Any feedback is REALLY appreciated. Feel like I've hit a wall recently with these.
PROGRESS: 2 of the city pages are on page 1 (but not in the top 3). All other city pages are between pages 2-4. She ranks #1 nationally for her chiropractic technique which was much lower competition, so Google likes the site at least a little.
What should I try from here? Do the city pages just need more links?
OBSERVATION: 99% of other chiropractors that rank in these respective cities rank with their homepage. We are trying to rank in multiple, which is why I went with the URL structure domain/california/city
FRANKENSTEIN THOUGHT: Does it make sense to build citations to each city page even though she only has 1 office?
Again, thanks for reading. ANY feedback is super appreciated!!!
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Ammon 🎓
Back up a step.
Sure, we get what you want. More customers. But in business, what the owner or their backers want doesn't matter a damn.
What matters is whether customers in those other places want to travel that far, in need of a chiropractor, for a chiropractor. What evidence do you have that that demand is there and present, and giving you a huge opportunity that just needs visibility?
Because just being visible with an offer nobody wants isn't going to do anything but waste your time, and annoy the thousands of people in those other places having to scroll past an ad that is, to them, utterly irrelevant results.
Make sure your logic works before investing time and effort.
There's always this idea that all we need to do is reach more people. With most actual practices that's nonsense, even without a service radius reality.
Are you getting all the customers in your home location yet? Have all the other chiropractors gone bust? If not, then you probably need to be a lot more worried about your conversion rate, customer attraction to those you do reach, and of course, your customer lifetime value stuff.
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Gerencser
To back up Ammon's post. I have had chiro.clients and we did what you are talking about, ranked very well in a lot of neighboring cities. I think we may have gained 1 new patient from those cities every other month. There was simply no value in doing that.
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John » Ammon
Ya this is key, are people willing to travel. In some niches I work in, people will travel 45 mins – 2 hours. Others, don't want to cross the street haha.
Ammon 🎓 » John
quite so. And in addition to what Gerencser already confirmed, it isn't just that it brings LESS customers … It also tends to bring bad ones. People who already pissed off all the local service providers, and are far, far more likely to be a bad customer for you too, and to give you the bad review they already gave all their local ones so they had to travel so far…
Seriously, I've seen businesses have their ratings tank suddenly, with more negative reviews, low ratings, bad word of mouth, etc. simply because they didn't think *who* has to travel outside their own area.
Peterson
+1 on this based on what i hear from friends as patients. They'll travel if the Ahrefs Domain Rating (DR). is amazing or highly recommended by word of mouth, otherwise the closer the better, especially with back pain.
I've traveled for specialty doctors at academic institutions… because…specialty.
Ammon 🎓 » Peterson
Exactly this, and why word of mouth, network marketing, and influencer marketing can be especially important for this kind of service.
Is there a local school, college, or university that has a sports coach that isn't recommending you? What about all the gyms?
Get out there and, as the famous book put it: Win Friends and Influence People. But specifically win over and influence the people who are in a perfect position to influence dozens of others.
Investing some time into some solid, proven, classic, real-world marketing is generally going to pay off a lot, lot better than getting listed outside your realistic service area.
Peterson » Ammon
And in the cases that I'm thinking for "somewhat local" it was friends recommending to friends that had similar pains. For this type of thing it's a combination of providing amazing services and solutions that people naturally recommend. And the recommendations are very trusted because of the direct relationships + outcomes.
For the academic inst. example, it was a LONG TIME family doctor making both recommendations AND phone calls. The examples are fairly different, but professional recommendations could work if the original doctor trusted/respected with a direct relationship.
Capo ✍️ » Ammon
(and others) thanks for the time and responses! Really appreciate that. Totally hear you on the location thing and people possibly not wanting to drive. MORE CONTEXT: the home city where the office is based is population 13,000. There are 3 cities that directly border it, all within a 5-10 minute drive to their office. That's why we thought it made sense to go for the neighboring cities.
Ammon 🎓 » Capo
There are definitely times it makes perfect sense to widen the area, and there are just as definitely times where it really doesn't, and can even be a bad thing. That's why I say you need data, really looking at the range people currently travel from (and the percentages involved).
A huge part of being an SEO is that we tend to have a different approach to stuff. A different way of looking at problems, or gathering data, and most especially, in creating our workarounds and compromises.
Determining whether a specific niche or market (or keyword phrase) is actually worth chasing, without wasting time, is absolutely a part of Search Engine Optimization (SEO) that is also applicable in the wider, offline side of marketing.
It is that SEO mindset that lets you think of smart ways to get the data you need.
For instance, is the main reason for losing long-term clients (customer attrition, happens to all businesses) because those customers move away, and if so, what are the distances? That's one way of graphing for yourself exactly what an effective radius is – finding the minimal distance at which even a loyal, satisfied customer determines that distance has outweighed that loyalty and satisfaction. (Obviously, someone without that customer loyalty, and relationship won't travel that far without it).
A 5-10 minute drive sounds entirely reasonable, but that may not be as true with neck pain, back pain, shoulder pain, etc. More to the point, the big factor becomes how many closer chiropractors will you go past to go to a specific one, when in pain? Taking that further into the 'why' – the specifics of when and why people will go beyond the closest – is where some of your best marketing (including keyword selection, content creation, etc) will come from.
You may have noticed that I spoke particularly of 'influencers' in my bit about networking. Thinking about what specific types of people people would trust a recommendation from, or even approach to ask for such advice.
Well, only an SEO mindset tends to apply this to their searches too. What are the searches someone goes to *BEFORE* they know they need a chiropractor? What would the search history of your client's best customers look like? Now, create content to rank for those, and you have the customer before they even realized they needed to search specifically for a chiro, right?
Capo ✍️ » Ammon
All great points. Thanks again for the insight. It's true, for other random services, people may drive 5-10 minutes for it. For people in pain, they might not. We're also trying to rank for other long-tail keywords, thinking in the exact train of thought that you mentioned of "what are people searching before they know they need a chiropractor" … From what I've found so far, many of those keywords are dominated by larger health websites answering queries like "how to treat neck pain" and things like that. We're still going for those non-location based keywords but I think it might be hard to rank for them initially. Going to still try though! Thanks again.
MORE CONTEXT FOR THIS SPECIFIC BUSINESS: the technique they practice is pretty unique. They don't do any cracking (I know sounds weird). So many of their practice members don't come in for a quick fix (some do), but many end up staying as practice members for several years.
MORE CONTEXT AGAIN: The business started <2 years ago. So totally agree! Lots of ways to market and network and grow the biz and find new clients. Since I know SEO (kind of), that's what I'm trying to help them with. They're doing lots of things in-person marketing and networking things to grow too.

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Kasim
I have ranked multi locations site and the core difference is URL structure for me
The shorter the URL the better ranking I have:
Domain/city-service
Is the domain branded? What type of anchors have you pushed towards the homepage?
Have a custom map on home page and cover all the locations in there and link from home page to each location
Check what the top 10 have for the 2 ranked city pages and reverse it and do the same
How old is the website and the pages created?
A lot can be done once the website is analyzed in depth to find the issues

John » Kasim
I do agree with the shorter URL as well.
Capo ✍️ » Kasim
Thanks for the response. So interestingly enough, I thought that too. There's a few nearby neighboring cities we're trying to rank for. To test, when I first made the pages, I setup different URL structures to see which one Google liked more. I tried domain/city-service for a few and domain/state/city-service for others … my findings were that the domain/state/city-service ones did better (without me doing anything else SEO-wise to them) by a landslide. I was surprised, because my other real estate website, I did your recommended URL structure domain/city-service and those do well. Not 100% sure if it's just the chiropractic niche?
I mirror this national chiropractic website that does really well with Search Engine Optimization (SEO).
Not exactly that URL structure, but added that state of California in there since 'The Joint' did too.
$29 Chiropractor Encinitas, CA | The Joint Encinitas
THEJOINT.COM
$29 Chiropractor Encinitas, CA | The Joint Encinitas
Kasim » Capo
Take the page you sent as example and rank the other two city pages to top.
Check backlinks, anchors ratio, supporting pages & internal linking.
Compare to the top 10 then build a plan based on that.
Run Google ads as well to see if these city pages will generate leads.
PM me if you need help further.
Capo ✍️
Thanks!

Rathi
Agree with Ammon's comment above; the conversions are poor and indirectly proportional to the efforts involved.
Still if you want to try; build out service pages per location; check out what kind of siloing competitors have done and how many sub pages are powering up the homepage and do similar or better;
Yes, citations to each page are needed.
Truslow 🎓
Results like this are localized in organic search already – and Google generally knows how far a person is willing to drive in order to go obtain a service. Where there is a lot of competition in a small area, the radius it chooses may be small. If you're in a rural area without a lot of other chiropractors – you may see yourself showing up in results an hour away. It all depends.
Creating service pages for each town can sometimes still work – but as Ammon and Steve has pointed out – even if it does, it may not really provide value.
Even more than that, though… it creates what I call "reality dissonance". So, if you have one office in say West Hartford CT and then you create separate pages for the adjoining towns like Avon, Bloomfield, Hartford, etc. you're creating a picture of something that doesn't exist. This can have a negative affect on both conversion rates AND ranking.
If I search for "Chiropractor in Avon" and then I land on your Avon page, I look at it and say, "Liar! You are in West Hartford – not Avon! I asked for one in Avon!" And then I don't just go away – but I go away angry.
This can negatively affect how Google builds out your brand and service entity in the knowledge graph, too. You have one location – in West Hartford – but you have all these pages saying that you're in Avon, Bloomfield, Hartford, etc. I'm Google – and I know you're not. Therefore, you're trying to trick me – so not only am I, The Great Google Machine, going to ignore those near town signals, I'm not going to have much trust and faith in anything else you tell me either. This can make it VERY difficult to get your knowledge graph connections created. That can be fine if you're in an area with little or no competition, but it's death if you're in a competitive area.
Location pages for services make more sense (though they aren't always necessary anymore) because you actually go to them. For a place where you are asking people to come to you and you're only in one place – trying to say that you're somewhere else just doesn't match up with reality. As time goes on and the knowledge graph grows, you're going to need to make sure what you say and how you position and structure your online presence matches reality as closely as possible.

Ammon 🎓 » Leon
I have no doubt that Stock will answer for himself, but for my take on it, Google do their own localization on a lot of services.
Without adding a location to your search terms, search for any service type that tends to have a service area. Try a Butcher, a Roofer, a Landscape Gardner, a Building Contractor, or even a Defense Attorney, and the chances are that Google will already serve localized results based on how far most people are willing to travel.
You don't need a location page for this, just a page about what service you provide, and your own address, and Google will automatically do the rest.
Truslow 🎓
Yep. Ammon is spot on for the retail stuff, yep. And for businesses where you do out-call – define your service area in your GMB listing, your schema, and even your service page just defining your service area by listing the towns, counties or even drawing a geoshape on a map does it.
https://support.google.com/business/answer/9157481?hl=en&co=GENIE.Platform%3DAndroid
Also define that service area on your site – either listing the towns or whatever on each specific service page or having an "area served" page that lists them all is enough. You don't really need those individual pages anymore. They still work sometimes – but they are also starting to cause problems for many folks – for example having 100 service/town combinations is a common cause of the "crawled not indexed" thing people keep complaining about.
SUPPORT.GOOGLE.COM
How to use a service area on Google for service-area & hybrid businesses – Android – Google Business Profile Help
Capo ✍️ » Truslow
Thanks for the response and insight! Super true, and a good reminder to think from the user's perspective!! Since most of the cities are super close (within 5-10 minute drive from their office) I thought that people still wouldn't mind driving but maybe some would! But right, I wouldn't want to make people think there was ACTUALLY an office somewhere their wasn't. Only nearby to where they are searching. Thanks again for the input!!

Muha
My question is "why do you want to be visible in a location where you can't offer your service?"
And most importantly, will people travel to have your service?
I think you should focus on conversions rather than getting higher ranks for other cities.

Capo ✍️ » Muha
As I mentioned above, it's mainly because her home city where her office is located is tiny. 13,000 population and 5 minute drive top to bottom. There are 3 neighboring cities that share borders with her city. So I thought it would make sense to try ranking in those too since they are all within a 5-10 minute drive from her office. Will people travel is the question. People above brought up a good point that if someone is in pain and needs a chiropractor ASAP, they're less likely to travel because they need instant pain relief.

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